Is Ebola spinning out of control?

The international travel restrictions on passengers from Uganda and health alerts over Ebola Virus Disease (EVD) outbreak in Uganda have increased concerns about the effectiveness of the government’s response to the epidemic.
The United States government announced on Thursday that all US-bound passengers, who have been in Uganda in the 21 days prior to their arrival, will be routed to one of the five airports for enhanced screening.

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“Out of an abundance of caution, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) Customs and Border Protection (CBP) will apply new layers of screening at these five US airports in response to the Ebola outbreak in Uganda,” the US Embassy in Uganda said in a statement on their website.
The passengers will be routed to New York (JFK), Newark (EWR), Atlanta (ATL), Chicago (ORD), or Washington (IAD), according to the embassy.
Similarly, the government of the United Kingdom, in an October 6 statement on their website, alerted health workers and heads of hospitals in their country to pay attention to those who are coming from “affected areas.”

Red flags
The alerts and restrictions came a day after the World Health Organisation (WHO) released figures on Ebola that are higher than those reported by the Health ministry.
“WHO is continuing to support the Government of Uganda to respond to the Ebola outbreak in four districts. So far, 63 confirmed and probable cases have been reported, including 29 deaths. Ten health workers have been infected and four have died,” Dr Tedros Adhanom Ghebreyesus, the director general of WHO, said.

By then (October 5), the data from the Health ministry indicated that the Ebola cases were at 43, with deaths at 10. The ministry is only reporting confirmed cases, leaving the probable Ebola deaths that happened before the outbreak was announced on September 19 unaccounted for even as the country looks for the index case.

The limited reporting by the Health ministry was, inter alia, triggered by an outcry by the Tourism ministry and players in the tourism sector that Ebola numbers were scaring away tourists as the country struggles to bolster its foreign exchange earnings.
Dr Jane Ruth Aceng, the Health minister, said the country—with support from partners—is making “good progress” in containing the outbreak. She said more people (seven) had recovered from the disease and the government is doing its best to bring the epidemic to an end.

“When we declared the Ebola epidemic on the 20th of this month, Ebola had already been in the sub-county of Madudu [in Mubende] for over 10 days. And it took one of the patients to tell us that people were dying in his village. Because he told us the truth, we started the response,” Dr Aceng said.
Dr Aceng said they have increased community engagement for a more effective fight against the contagious disease, whose mortality ranges from 25 percent to 90 percent.
Dr Aceng said no new cases of the virus infection were reported on Tuesday, signalling the effectiveness of the response which is aimed at curbing the spread and treating those infected.

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Witchcraft, politics rear ugly head in Ebola fight

Death of medics
Elsewhere, the EVD deaths, specifically those of four health workers, have triggered questions around the effectiveness of strategies to protect those to whose care Ebola patients are entrusted.
Dr Samuel Oledo, the president of the Uganda Medical Association (UMA), said on Tuesday, that before the death of Margaret Nabisubi, who was battling EVD at Fort Portal Hospital, the care the anaesthetic officer was receiving was “lacking.”

Following Nabisubi’s death on Wednesday, Dr Githinji Gitahi—the Group chief executive officer for Amref Health Africa—one of the major supporters of Uganda’s health system, said on Twitter: “This is getting out of hand! We need to protect health workers with PPEs (personal protective equipment), infection prevention and control in patient care and management, including hygiene, health insurance, risk allowances and mental health. Urgently!”

However, Dr Diana Atwine, the Permanent Secretary in the Ministry of Health, said: “Those were the health workers who got exposed to index cases. We have not registered more secondary infections. Our interventions are effective and we have not registered any positives in the last 72 hours.”
Dr Aceng, on the other hand, said they have intensive care unit equipment and they are giving the best possible care. 

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Outbreak is complex
Dr Stephen Ataro Ayella, a clinical epidemiologist, who was involved in the response to Ebola outbreaks in Bundibugyo in 2007, Liberia in 2014 and DR Congo in 2019-2020, said this outbreak is a bit complex.

“If you look at the previous outbreaks, usually they were localised within one or two districts. Like for the outbreak in Bundibugyo, it took some time before the virus went to Kasese,” he said, adding, “But if you look at this one, it has spread to four districts and that tells you about our mobility.” Dr Ataro, however, said the country has developed the capacity to handle the outbreak.
Uganda has previously battled seven Ebola outbreaks driven by three main stains, including Ebola Bundibugyo, Ebola Zaire and Ebola Sudan, according to the Health ministry. The Ebola Sudan strain, which triggered the latest outbreak in the country, has no approved vaccine to combat it and no approved drug for treatment.

“The outbreak in Gulu was very fatal because by then, Uganda had not yet developed a strong system, but now the system is better. For this current one, we had some structure for the Covid-19 response,” Dr Ataro said.
He added: “We had the incident team for Covid-19, which was moved to handle Ebola.”

READ: US to screen travellers from Uganda for Ebola
Ebola
The latest statistics from the Health ministry indicate that 10 people have died out of 44 infections. The seven recoveries registered also include a pregnant woman, who was discharged from the isolation unit at Mubende Regional Referral Hospital on Thursday. 
Ms Christen Nyangoma, a resident of Madudu Sub-county, was among the four negative cases registered at the isolation unit on Thursday. 

Dr Paskar Apiyo, a team leader at the unit, revealed that three of the four people were discharged.
The taskforce in Mubende, which is the ground zero for the latest outbreak, revealed that it is yet to make contact with a runaway positive Ebola case. The patient escaped from the isolation facility and is believed to be highly infectious.
Additional reporting by Dan Wandera