Why the Ebola outbreak in Uganda matters to you

If there’s one thing we’ve learned from COVID-19 and monkeypox, health experts say, it’s that viruses are world travellers — and disease outbreaks are developing at a fast and furious pace.   

Now, as Uganda fights an Ebola outbreak, doctors are urging rich countries like Canada to pay attention.   

“We know from past outbreaks that preparedness is key and that a disease can spread anywhere rapidly,” Dr. Patrick Otim, who is leading the World Health Organization’s (WHO) Ebola response in Uganda, told CBC News in an email. 

“Global solidarity when it comes to sharing resources, supplies and expertise can be the difference between a localized public health threat and a global one.”

Authorities declared an outbreak of Ebola virus on Sept. 20. The disease is devastating, with death rates ranging between 25 to 90 per cent in past outbreaks in Africa. Although the root of this specific outbreak hasn’t yet been confirmed, Ebola is often thought to originate in fruit bats and then infects other wild animals. 

Medical lab assistant Mellon Kyomugisha takes a blood sample from a toddler at the clinic in Madudu, near Mubende, Uganda on Sept. 28. (Hajarah Nalwadda/The Associated Press)

Humans initially become infected through contact with animals — including when hunting for bushmeat. Then, it spreads between humans through direct contact with bodily fluids, including blood, vomit, feces, saliva or semen. Without proper personal protective equipment, people can become infected while caring for an Ebola patient, handling their bedsheets or burying the body of someone who has died from the virus.

Right now, there are dozens of confirmed cases across Uganda, and the disease has killed at least four health-care workers, according to the WHO. Health authorities are not only trying to save patients’ lives, they’re also trying to prevent the virus from spreading to neighbouring African countries. Both are tough feats, given there is not yet a licensed vaccine for this particular kind of Ebola — known as the Sudan strain — nor a drug treatment beyond keeping patients hydrated and managing symptoms. 

There’s reason for hope though. 

Ugandan and international scientists are planning to test a vaccine candidate, developed by the Sabin Vaccine Institute and the National Institutes of Health (NIH) in the U.S., that has shown promise against the Sudan strain in early-stage trials, said Dr. Yonas Tegegn Woldemariam, WHO representative to Uganda, in a media briefing Thursday. The hope is that it will be as successful as the Ervebo vaccine has been against the type of Ebola known as the Zaire strain, which drove many previous outbreaks. 

Doctors walk inside the Ebola isolation section of Mubende Regional Referral Hospital. (Hajarah Nalwadda/The Associated Press)

Battling Ebola requires a lot of resources — from personal protective equipment to test kits to expertise — so it’s critical that more prosperous countries support Uganda’s medical response now to save lives and money, said Dr. Boghuma Kabisen Titanji, an infectious diseases specialist at Emory University in Atlanta.

“You need to make the investment early on to squash an outbreak and not wait for it to affect the U.S. or have a case imported into Europe to then raise the level of alarm,” she said. 

Taking a global approach to health care and providing necessary medical and humanitarian assistance quickly is the best way for Canadians to defend against Ebola and other disease outbreaks, agreed Dr. Joanne Liu, a professor at the School of Population and Global Health at McGill University and former international president of Doctors Without Borders. 

“If you want to beat an outbreak and avoid an outbreak … [moving] to an epidemic to a pandemic, your response needs to move faster than the virus,” Liu said. “So we cannot wait.” 

Thousands of people died in a widespread West African outbreak of the Zaire Ebola strain between 2014 and 2016, but there was no sense of urgency from rich countries until it hit close to home, Titanji said.

“I mean we had had vaccine candidates for Ebola [Zaire strain] that were sitting on shelves for 10 years, just lacking the investment in research,” she said. 

“It was only when we started seeing importation of cases to European countries and to the U.S. that we had a heightened sense of, ‘Oh my God, this is now a public health emergency of international concern.'”

‘You need to make the investment early on to squash an outbreak and not wait for it to affect the U.S. or have a case imported into Europe to then raise the level of alarm,’ says Dr. Boghuma Kabisen Titanji, an infectious disease specialist at Emory University in Atlanta. (Boghuma Kabisen Titanji )

During that previous outbreak, there were four cases of Ebola in the U.S., including one death, according to the U.S. Centers for Disease Control and Prevention (CDC).  There were no known cases in Canada. 

Current Ebola risk in Canada and U.S. low

Although the risk of getting Ebola in Canada or the U.S. is low, even one case is “a house on fire situation,” said Dr. Syra Madad, an infectious disease epidemiologist at the Harvard Kennedy Belfer Center for Science and International Affairs.

Ebola’s high fatality rate and the intensity of care required make it a “low probability but high consequence” disease, she said. 

The CDC recognized those stakes on Thursday, issuing a precautionary health advisory asking health-care providers in the U.S. to take a travel history of patients with common initial symptoms of Ebola, “including fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms and unexplained bleeding.”

The U.S. administration took precautions a step further, announcing that passengers who have travelled to Uganda would be screened for Ebola in five airport hubs.   

Even one case of Ebola is ‘a house on fire situation,’ says Dr. Syra Madad, an infectious disease epidemiologist at the Harvard Kennedy Belfer Center for Science and International Affairs. (Submitted by Syra Madad)

There’s no indication that Canada will be doing similar passenger screening, although on Friday the Public Health Agency of Canada issued a travel notice recommending that travellers take extra precautions when visiting Uganda.

A spokesperson for the agency said in an email to CBC News that it “is monitoring the situation globally and will continue to assess the risk to Canadians as new information becomes available,” noting that Ebola is “not spread through casual contact.”

“The Government of Canada has systems in place to identify and help prevent spread of serious infectious diseases in Canada,” the email said.

“We remain prepared to detect, investigate and manage cases of Ebola in the unlikely event that a case arrives in Canada.”

Climate change means more epidemics, doctors say 

If you feel like there’s one health emergency after another these days, experts say that’s no coincidence. 

“The phenomenon of outbreaks becoming potentially epidemic and pandemic is happening over and over again,” said Liu.

“If we go from SARS in 2003 to COVID-19 in 2020 to Ebola today, it’s just like each time the lapse of time between those events is shorter.” 

Health emergencies are growing in frequency, largely because of climate change and its effect on animal-to-human virus transmission, says Dr. Joanne Liu, a professor at the School of Population and Global Health at McGill University. (Rodolph Beauliu)

International travel is a factor, but a major culprit is climate change, doctors say. 

Pressures that we put on the environment, such as clearing forests, affects the animals who carry viruses, which increasingly causes “spillover” to humans, Liu said. 

“Viruses and infectious pathogens do not care how exhausted we are by these outbreaks,” Titanji said. 

“The collision between climate change, increased population movement, increased interaction with animals and our environment … increases the potential that we will see more outbreaks of infectious diseases.”

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