By Simon RozePosted on 19-03-2019Modified on 19-03-2019 at 10:10

More than seven months after its start, the Ebola epidemic in north-eastern DRC has just exceeded 600 deaths. The World Health Organization (WHO) however considers the epidemic contained, and even plans to see the end in six months. An achievable goal, but one that requires a change of approach.

Every day, new cases of Ebola in the DRC are counted on the fingers of one hand. Clearly, a peak has passed, prompting WHO to declare the epidemic " contained ". For many observers, the use of this term is probably a bit premature. " The epidemic is not under control, " says Dr. Natalie Roberts. The emergency director of Médecins sans Frontières Paris has just returned from North Kivu. It parallels the epidemic that has hit West Africa : "There is a risk today of seeing an outbreak and many more cases. Our goal is to understand what are the risk factors and avoid what we saw in West Africa. The epidemic seemed then contained, but it preceded such an outbreak. In the DRC, we still do not understand why and how people catch Ebola. "

During her stay, however, Natalie Roberts was able to observe the situation, which led her to formulate several hypotheses. Nosocomial transmissions at the hospital are thus at the top of its list, as is the so-called chain of contamination: the contacts that a sick person has with his entourage. It must be possible to trace this thread. " When a case is identified in a family, our teams arrive to identify contacts, " explains Jean-Christophe Shako. The coordinator of the disease response does this work every day in Butembo. " All contacts are listed, vaccinated. Then we decontaminate the structure, clean it up. We mostly follow all contacts for 21 days. " Long-term work and the doctor regularly observes the reluctance of the population, which complicates the task even more, with potentially serious consequences. " If these operations are not carried out, contacts will develop the disease. That's what's causing us problems now. "

Go faster in the care

Ebola is indeed a scary disease, and the first reflex is not to go to an Ebola center as soon as the first symptoms appear. The sick simply go to the nearest hospital. This has two perverse effects: the increase in nosocomial infections mentioned by Natalie Roberts, but also a crucial loss of time. The doctor estimates that, on average, patients go to three different health centers before going to an Ebola facility.

To remedy this, the idea is to change the approach, and to move towards greater integration of the Ebola treatment chain into already existing structures. In Lubero, for example, " there is no Ebola center, we only have the general reference hospital , " says Dr. Grégoire Tshilongo of MSF. " All the patients go through there, there is only one sorting. We have an isolation room for all suspected cases. We can keep them there and take the samples. If the test is positive, the patient is referred to an Ebola specific course. If he is negative, he is treated in the hospital.

For MSF, this approach has several advantages. Firstly, there is no longer a waste of time in the management of the disease: the patient has access to screening as soon as he or she enters the treatment pathway. The establishment of isolation rooms in a general hospital also limits the risks of nosocomial infections.

However, this system should be generalized in order to equip each health center in the region with staff and infrastructure to be in contact with the disease. The World Health Organization seems to be moving in this direction. " Our priority must be working with communities by building their capacity to cope with the epidemic, " said Tedros Ghebreyesus Adhanom, WHO's Director General. " I fully agree with MSF on this, it's now part of our strategy . "

An unstable security context

The end of the epidemic is therefore possible. However, it will be necessary to override the security risk: " In this region, there are armed conflicts since many decades and the communities are always cautious ", continues the boss of WHO, which warns against the risk that the epidemic is on the rise " if the security situation continues to deteriorate . "

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