PART 12. June17, 2019. “Three cases of EBOLA have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.”

In a “worst-case scenario,” the current Ebola outbreak in the Democratic Republic of Congo may take up to two years to end….

San Antonio found itself ill-prepared to handle a sudden influx of refugees from the Democratic Republic of Congo.

ASSIGNMENT: What immediate actions should be taken in the United States?

PARTS 1-11, May 15, 2017 to August 30, 2018, after new PART 12. 

PART 12. June17, 2019. “Three cases of Ebola have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.”

“Dr. Jeremy Farrar, director of Wellcome Trust, a UK medical research charity, said that while Uganda was well-prepared to cope with the disease, global health authorities should be ready for more cases in the Democratic Republic of Congo and other neighboring countries.

“This epidemic is in a truly frightening phase and shows no sign of stopping anytime soon,” he said in a statement.

“There are now more deaths than any other Ebola outbreak in history, bar the West Africa Epidemic of 2013-16, and there can be no doubt that the situation could escalate towards those terrible levels.”..

WHO is likely to come under pressure to declare the outbreak an international health emergency. In April, the health body said it did not constitute a “public health emergency of international concern.”

WHO defines a public health emergency of international concern as “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “to potentially require a coordinated international response.”’’

“A step up in the national response with full international support is critical if we’re to contain the epidemic and ensure the very best protection for the communities at risk and for the health workers working to protect lives,” Farrar said. “This needs to be championed at the highest political levels, including at the UN and the upcoming G20.” (A)

“Three cases of Ebola have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo (DRC), officials said.

On Tuesday, the World Health Organization (WHO) announced that a 5-year-old boy had been diagnosed in Uganda, apparently after crossing over from the DRC. WHO officials said it was the first Ebola case in Uganda during the ongoing outbreak in the DRC.

Then, early Wednesday, Uganda’s health ministry said two additional cases had been diagnosed — the boy’s grandmother and a 3-year-old sibling, now in an isolation unit. The ministry also said the 5-year-old had died.

In an all-too-familiar scenario when it comes to infectious diseases, the cases appear to be travel-related. When the 5-year-old became ill, the family sought care at a hospital in Bwera, Uganda, which is less than a mile from the DRC’s eastern border. Ebola was identified as a potential cause of illness, the WHO said.

“This is a sobering development that everyone has been working to avoid, and highlights the complexity of the Ebola outbreak in the Democratic Republic of the Congo,” said CDC director Robert Redfield, MD, in a statement about the first case.

Uganda was not entirely unprepared for imported Ebola, as about 4,700 health workers in the country have already been vaccinated in 165 health facilities. The WHO and the country’s Ministry of Health have dispatched a rapid response team to identify, monitor and care for those who might be at risk. In addition, those who have come into contact with the patient, as well as at-risk previously unvaccinated health workers, will be vaccinated, they said…”  (B)

“Twenty-seven people are said to have been in contact with the three confirmed cases in Uganda. They have been restricted to their homes and will be vaccinated against Ebola.

The people who fled from a hospital isolation unit had been found to have high temperatures when they crossed the border from DR Congo to the Ugandan district of Kanungu, which is about 150km (93 miles) south of Kasese. Medical workers did not get a chance to take samples of their blood to send for testing before their escape.” (C)

“Over the weekend and through today the Democratic Republic of the Congo (DRC) reported 23 new Ebola cases, 2 of them in healthcare workers and one involving a reintroduction of the virus into an earlier affected area…

The cases involving healthcare workers are in Mabalako. One worker is a vaccinated nurse who agreed to be taken to an Ebola treatment center after she tested positive for Ebola, marking the second case at the same clinic following the admission of several Ebola patients. The other is also a vaccinated health worker, raising the cumulative number of cases in healthcare workers to 113.” (D)

“The World Health Organization warned Friday that it may not be possible to contain Ebola to the two affected provinces in eastern Congo if violent attacks on health teams continue.

The ominous statement comes amid escalating violence nine months after the outbreak began, crippling efforts to identify suspected cases in the community and vaccinate those most at risk. Earlier this week, Mai-Mai militia fighters attacked the town of Butembo at the epicenter of the crisis.

The update also noted that a burial team had been “violently attacked” after they interred an Ebola victim in the town of Katwa. The corpses of victims are highly contagious, requiring special precautions to ensure the disease is not transmitted at funerals…

David Miliband, president of International Rescue Committee, has met with health workers in the regional capital of Goma this week. Some fear it could take another year to get the disease under control, he said.

“There is a real concern to make sure it doesn’t spread to Goma,” he said. “And so this is, I think, a more dangerous situation than is widely recognized outside the country.”..

In addition to the risks posed by militias there also has been widespread community mistrust in eastern Congo, a byproduct of years of conflict and grievances with the government. WHO said it was aiming to have the of majority vaccine teams comprised of local health workers by the end of the month in an effort to reduce tensions.” (E)

“In a “worst-case scenario,” the current Ebola outbreak in the Democratic Republic of Congo may take up to two years to end, a World Health Organization official said Thursday.

The outbreak, which began Aug. 1, is “not under control,” Mike Ryan, executive director of WHO Health Emergencies Programme, said during a press briefing. “We may end up dealing with this outbreak for a long time.”..

Dr. Ryan said that numbers have stabilized and even fallen in the last two weeks, yet he also said there’s still “substantial transmission” in some health zones. While there is a smaller geographic footprint, the spread of disease is rampant within affected zones, he added.” (F)

“The World Health Organization is considering whether to declare the current Ebola outbreak in central Africa a global health crisis after new cases spread to Uganda from neighboring Democratic Republic of the Congo, where the disease has already killed nearly 1,400 people…

A WHO expert committee on the outbreak was scheduled to meet for a third time, this time on Friday in Geneva, where it will discuss whether to declare a global health emergency.

The latest Ebola outbreak, centered in northeastern Congo, was declared in August. It is “by far the largest” of 10 such outbreaks in the country in the past 40 years, according to Doctors Without Borders.

Meanwhile Rwanda, which neighbors both the DRC and Uganda, says it is tightening its borders with both countries and the government is urging people not to travel to affected areas, according to the state-backed newspaper The New Times.

Earlier this year, Rwanda said it would begin issuing front-line health workers an experimental Ebola vaccine in an effort to keep the disease from crossing into its territory. And Uganda’s health ministry has been encouraging its public to get the vaccine, assuring them of the vaccines safety and effectiveness, Aceng said in a statement.”..(G)


“We are entering a very new phase of high impact epidemics and this isn’t just Ebola,” Dr Michael Ryan, the executive director of the WHO’s health emergencies programme told me.

He said the world is “seeing a very worrying convergence of risks” that are increasing the dangers of diseases including Ebola, cholera and yellow fever.

He said climate change, emerging diseases, exploitation of the rainforest, large and highly mobile populations, weak governments and conflict were making outbreaks more likely to occur and more likely to swell in size once they did.

Dr Ryan said the World Health Organization was tracking 160 disease events around the world and nine were grade three emergencies (the WHO’s highest emergency level).

“I don’t think we’ve ever had a situation where we’re responding to so many emergencies at one time. This is a new normal, I don’t expect the frequency of these events to reduce.”

As a result, he argued that countries and other bodies needed to “get to grips with readiness [and] be ready for these epidemics”.

It took 224 days for the number of cases to reach 1,000, but just a further 71 days to reach 2,000.” (H)

High impact disease outbreaks such as Ebola could become the “new normal”, the World Health Organization has said…

 “We are entering a new phase in terms of high impact epidemics and this isn’t just Ebola. You look at cholera, yellow fever, many other diseases – we’re seeing both re-emergence and resurgence,” Dr Ryan said.

He added that 80 per cent of such epidemics were occurring in fragile, conflict-affected states such as DRC.

“So we’re seeing a very worrying convergence of risks. Areas of high biodiversity, high population density, high population mobility, weak governance, conflict and many other things layered on top of each other,” he said.

WHO is currently monitoring 160 different disease events around the world, including 33 emergencies, nine of which are grade three, requiring the highest level of operational response.” (I)

“When West Africa was declared Ebola-free in January 2016, the international community — having realized how the world’s weakest health systems threaten global health security — vowed that never again would we let such a health crisis fester until it became a calamity. A period of unprecedented attention to global health security began.

We had learned the importance of a rapid mobilization after the World Health Organization’s (WHO) egregious failure to sound the alarm until months into outbreak. We saw the necessity to declare the highest level of global emergency to secure political commitments and mobilize scarce resources.

We discovered that distrust of government often obstructed the response, and that every means must be sought to vest the affected populations, enlisting traditional leaders, priests, imams, midwives, youth leaders, civil society, local journalists, anyone with a trusted voice.

And it was the United States that led the global scale-up, including the deployment to Liberia of the 101st Airborne.

Three years later in the Democratic Republic of the Congo (DRC), it feels like many of the lessons learned were learned in vain — and with the White House decision to bar U.S. officials, including the Centers for Disease Control (CDC), from entering the worst-affected zones as well as a strict interpretation of the Trafficking Victims Protection Act resulting in the withholding of non-humanitarian assistance, we have an unprecedented sidelining of U.S. expertise that — until now —has been on the frontlines for every Ebola outbreak…

Ebola was defeated in West Africa when a global declaration of emergency created the conditions for charities and frontline healthcare workers to get ahead of the Ebola transmission curve. The disease was brought under control only after it was acknowledged that you don’t isolate the communities, you work with them, to isolate the virus. And it was defeated with U.S. leadership.” (J)

“This outbreak has featured organized attacks on the response efforts, specifically targeting medical facilities and healthcare personnel in violation of humanitarian laws, reported Annie Sparrow, MBBS, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues…

“These attacks arouse concern that armed groups are exploiting the epidemic for broader military or political ambitions, and they have resulted in recurrent temporary suspension of response activities in affected areas,” the authors wrote…

Sparrow and colleagues agreed, writing, “Even in the middle of intractable conflicts, success in controlling Ebola must be achieved. We have the tools of global disease surveillance, rapid-response systems, and biomedical solutions — if there is the political will to protect health workers in conflict zones.”

Moeti described that the Ebola outbreak in the DRC as “one of the most complex health emergencies the world has faced,” adding that juggling the dual responsibilities of protecting staff and colleagues while responding to the outbreak is no small feat.” (K)

“Though community attitudes and the decisions of individuals contribute to how outbreaks spread, a broken health system seems to be the single largest contributor to how susceptible a country might be to an outbreak, and how quickly it can be stamped out.

During the West Africa outbreak, which was considerably larger and more deadly than the outbreak in Congo, most people who fell ill never had Ebola. Early on, sick patients waited days, sometimes weeks, for laboratory tests. When someone showed symptoms of Ebola, they were sent into a “holding unit,” hastily constructed tarpaulin-walled units, where it was hot and often crowded with make-shift cots.

Unfortunately, the symptoms of Ebola resemble many other diseases prevalent in the region and all sick people with Ebola-like symptoms were held in the same room, increasing the likelihood of transmission within the facilities themselves…

One of the key reasons Ebola spread so rapidly in Sierra Leone, Liberia and Guinea was that those countries’ health systems were woefully under-resourced to respond to basic health needs, let alone an outbreak of a deadly infectious disease. In Congo, the number of people who have access to comprehensive care is not just low — it’s basically zero…

America has a role to play. One of the greatest global health funding mechanisms was implemented by President George W. Bush, who created the President’s Emergency Plan for AIDS Relief (PEPFAR), which helped millions of people dying from HIV/AIDS access treatment. We need similarly bold and comprehensive aid packages for strengthening public health systems in poor countries — ones that fund training for the next generation of doctors and nurses, improve supply chains for essential medicines and build public teaching hospitals and clinics and other essential health infrastructure. Such a program would be a long-term commitment, untethered from a specific emergency.

Some Americans may argue that we don’t have a responsibility to fix health care in far-off places. President Donald J. Trump might be among them. The afternoon after Congo declared its latest Ebola outbreak, he cut $252 million for global disease prevention funding because it was “no longer needed.”

But even people who do not see this as a moral imperative should see it as a national security issue. Epidemics should worry us more than terrorists: tuberculosis, unlike Ebola, is airborne, and Congo has among the highest TB rates in the world. That impacts us all.”  (L)

“There are 88 nations where the per capita GDP is lower than that of Guatemala, which stands at $4,471 as of 2017. That is likely well over one billion people living in similar or worse conditions than those coming to our border today, primarily from Central America. As such, it’s no surprise that once our government telegraphed the message to the world that our sovereignty no longer matters when someone invades with a child, people are now coming in large numbers from all over the world, including from the most disease-prone countries in Africa.

While Africans have been trickling over our border in recent months, on Friday, Customs and Border Protection (CBP) announced that “the first large group of people from Africa” were apprehended in the Del Rio sector of Texas. In total, 116 individuals were apprehended in this African caravan on Thursday morning, including 35 from Angola, one from Cameroon, and 80 from Congo.

This demonstrates that the global migration, at this pace, will be a bottomless pit, because even if we eventually empty out the northern triangle of Central America, there are unlimited regions in the world where poverty is pervasive and from which people will travel to seek the de facto amnesty being offered…

With family units being released within days, often within hours, how can our government be certain that Americans, not to mention Border Patrol and local health officials, are not being put in danger? This is why the law (8 U.S.C. § 1222(a)) requires the government to detain all migrants “for a sufficient time to enable the immigration officers and medical officers to subject such aliens to observation and an examination sufficient to determine whether or not they belong to inadmissible classes.” This was for all migrants. It was always presumed that we would never take in people from specific countries that were experiencing deadly epidemics.” (M)

“For the third time, the World Health Organization declined on Friday to declare the Ebola outbreak in the Democratic Republic of Congo a public health emergency, though the outbreak spread this week into neighboring Uganda and ranks as the second deadliest in history.

An expert panel advising the W.H.O. advised against it because the risk of the disease spreading beyond the region remained low and declaring an emergency could have backfired. Other countries might have reacted by stopping flights to the region, closing borders or restricting travel, steps that could have damaged Congo’s economy.

Dr. Preben Aavitsland, a Norwegian public health expert who served as the acting chairman of the emergency committee advising the W.H.O., said there was “not much to be gained but potentially a lot to lose.” ..

Experts do not expect the Ugandan outbreak to spiral out of control.

Uganda has a strong central government and a cash-starved but organized health care system. It has endured and beaten three previous Ebola outbreaks, in 2000, 2007 and 2012.” (N)

“Neighboring countries have been preparing for the possibility that the virus might jump borders in a region where the population is highly mobile and where more than a million people are displaced from their homes because of decades of ethnic conflict.

Thousands of medical personnel in Uganda, Rwanda and South Sudan have already received a vaccine to protect themselves, and border guards have screened more than 65 million people crossing through 80 ports of entry and operational health checkpoints.” (O)

“In Uganda, the battle against Ebola will be determined by the government’s ability to win the confidence of the people. The country is not strife-torn like its volatile neighbour, and has a more robust health system. For the time being, at least, there is hope the disease will be contained in Uganda.” (P)

“The isolation ward for Ebola patients is a tent erected in the garden of the local hospital. Gloves are given out sparingly to health workers. And when the second person in this Uganda border town died after the virus outbreak spread from neighboring Congo, the hospital for several hours couldn’t find a vehicle to take away the body.

“We don’t really have an isolation ward,” the Bwera Hospital’s administrator, Pedson Buthalha, told The Associated Press. “It’s just a tent. To be honest, we can’t accommodate more than five people.”

Medical workers leading Uganda’s effort against Ebola lament what they call limited support in the days since infected members of a Congolese-Ugandan family showed up, one vomiting blood. Three have since died.

While Ugandan authorities praise the health workers as “heroes” and say they are prepared to contain the virus, some workers disagree, wondering where the millions of dollars spent on preparing for Ebola have gone if a hospital on the front line lacks basic supplies.” (Q)

“The Tanzanian Minister of Health issued an “alert” on Sunday following the outbreak of Ebola cases this week in Uganda, a country with which Tanzania shares a long border.“I would like to alert the public to the existence of a threat of an Ebola epidemic in our country following the outbreak of this disease in Uganda,” said Health Minister Ummy Mwalimu. She justified this warning by “the important interactions between the populations of the two countries via official borders or other unofficial channels”.” (R)

“Alexandra Phelan, a global health expert at Georgetown University, said the legal criteria for declaring Ebola a global emergency have long been met, even before the virus reached Uganda.

“I think the declaration should be made tonight,” she said. “Given that we are still seeing daily numbers of cases in the double digits and we do not have adequate surveillance, this indicates the outbreak is a persistent regional risk.”

Phelan said she was concerned WHO might be swayed by political considerations.

As the far deadlier 2014-16 Ebola outbreak raged in West Africa, WHO was heavily criticized for not declaring a global emergency until nearly 1,000 people had died and the virus had spread to at least three countries. Internal WHO documents later showed the agency feared the declaration would have economic and social implications for Liberia, Guinea and Sierra Leone.”

“It’s legitimate for countries to raise these concerns, but the basis on which WHO and its emergency committee should be looking at is the risk to public health and the risk of international spread,” Phelan said.”” (S)

“Today the U.S. Centers for Disease Control and Prevention (CDC) is announcing activation of its Emergency Operations Center (EOC) on Thursday, June 13, 2019, to support the inter-agency response to the current Ebola outbreak in eastern Democratic Republic of the Congo (DRC). The DRC outbreak is the second largest outbreak of Ebola ever recorded and the largest outbreak in DRC’s history. The confirmation this week of three travel-associated cases in Uganda further emphasizes the ongoing threat of this outbreak. As part of the Administration’s whole-of-government effort, CDC subject matter experts are working with the USAID Disaster Assistance Response Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to support the Congolese and international response. The CDC’s EOC staff will further enhance this effort.

CDC’s activation of the EOC at Level 3, the lowest level of activation, allows the agency to provide increased operational support for the response to meet the outbreak’s evolving challenges. CDC subject matter experts will continue to lead the CDC response with enhanced support from other CDC and EOC staff.

“We are activating the Emergency Operations Center at CDC headquarters to provide enhanced operational support to our expanded Ebola response team deployed in DRC,” said CDC Director Robert R. Redfield, M.D. “Through CDC’s command center we are consolidating our public health expertise and logistics planning for a longer term, sustained effort to bring this complex epidemic to an end.”” (T)

“San Antonio found itself ill-prepared to handle a sudden influx of refugees from the Democratic Republic of Congo.

The Texas city was reportedly not informed by U.S. Border Patrol that the migrants, who began arriving on Tuesday, were coming, according to Interim Assistant City Manager Dr. Colleen Bridger.

“We didn’t get a heads up,” Bridger told KENS 5 on Thursday.

“When we called Border Patrol to confirm, they said, ‘yeah, another 200 to 300 from the Congo and Angola will be coming to San Antonio,’” she added.

The refugees, fleeing the Congo where an Ebola epidemic that began last year has now surpassed 2,000 cases, arrived in the Alamo city after reportedly traveling to the southern U.S. border with a group of about 350 migrants through Ecuador.

The city says Border Patrol told them earlier this week (when the city reached out) to expect 200-300 more migrants from the Congo and Angola to arrive in the coming days.

Besides the burden of processing and sheltering the migrants, the city has found an added challenge of communication, as KENS 5 reported that San Antonio is now “in desperate need of French-speaking volunteers.”

About 375 people, from a total of 450 just on Wednesday at the Migrant Resource Center, were housed at Travis Park Church that night. Another center was opened to shelter hundreds more expected to arrive, but plans to send the migrants to other cities have not yet panned out.

“The plan was 350 of them would travel from San Antonio to Portland. When we reached out to Portland Maine they said, ‘Please don’t send us any more. We’re already stretched way beyond our capacity,” Bridger said. “So we’re working with them [the migrants] now to identify other cities throughout the United States where they can go and begin their asylum seeking process.”” (U)

“In Portland — the largest city in Maine, with a population of 66,417 — about 200 African migrants were sleeping on cots on Friday night in a temporary emergency shelter set up in the Portland Expo Center. The city has a large Congolese community, and has built a reputation as a place friendly to asylum seekers. It created the government-financed Portland Community Support Fund to provide rental payments to landlords and other forms of assistance for asylum seekers, the only fund of its kind in the country, Portland officials said.

Many of the recent African migrants do not have relatives in the country, so they are being released with no travel arrangements, a problem that local officials and nonprofit groups are forced to sort out.

The mayor of Portland, Ethan K. Strimling, said they welcomed African migrants, and a donation campaign for them had raised more than $20,000 in its first 36 hours.

“I don’t consider it a crisis, in the sense that it is going to be detrimental to our city,” Mr. Strimling said. “We’re not building walls. We’re not trying to stop people. In Maine, and Portland in particular, we’ve been built on the backs of immigrants for 200 years, and this is just the current wave that’s arriving.”” (V)


PART 1. May 15, 2017. EBOLA is back in Africa. Is ZIKA next? Are we prepared?

PART 2. May 9, 2018. New Ebola outbreak declared in Democratic Republic of the Congo

PART 3. May 18, 2018 . As ZIKA and EBOLA reemerge, Trump administration cuts funding to halt international epidemics

PART 4. June 11, 2018 . “With an outbreak like this, it’s a race against time, as one Ebola patient with symptoms can infect several people every day.”

PART 5. June 16, 2018.  EBOLA, ZIKA. EMERGING VIRUSES. “ All too often with infectious diseases, it is only when people start to die that necessary action is taken.”

PART 6. June 17, 2018. ANDEMIC PREPAREDNESS. “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”

PART 7. June 21, 2018 .D emocratic Republic of Congo’s Ebola outbreak has been “largely contained”…

PART 8. June 24, 2018.  “Slightly over a month into the response, further spread of [Ebola Virus Disease] has largely been contained,” WHO announced on June 20.

PART 9. August 10, 2018. After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner

PART 10. August 20, 2018. At least 10 health-care workers have been infected with the deadly Ebola virus as they battle an outbreak in an eastern province of Congo

PART 11. August 30, 2018.  “…(WHO) reports the next seven to 10 days are critical in controlling the spread of the Ebola virus in eastern Democratic Republic of Congo.”

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