tag:theconversation.com,2011:/fr/topics/ebola-6354/articlesEbola – The Conversation2023-05-11T05:28:46Ztag:theconversation.com,2011:article/2042842023-05-11T05:28:46Z2023-05-11T05:28:46ZAfrican scientists are working to pool data that decodes diseases – a giant step<figure><img src="https://images.theconversation.com/files/525336/original/file-20230510-19-rgkrh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">African scientists need a central repository where the genomic data they capture can be uploaded and shared.</span> <span class="attribution"><span class="source">iStock/Getty Images Plus</span></span></figcaption></figure><p>Infectious disease outbreaks in African countries are, unfortunately, all too common. <a href="https://theconversation.com/ebola-what-are-the-symptoms-how-does-it-spread-and-where-did-it-come-from-191518">Ebola</a> in the Democratic Republic of the Congo or Uganda; Marburg virus in <a href="https://theconversation.com/the-first-human-case-of-marburg-virus-in-west-africa-is-no-surprise-heres-why-166694">Guinea</a> or <a href="https://theconversation.com/what-is-marburg-virus-and-should-we-be-worried-200082">Equatorial Guinea</a>; cholera in <a href="https://theconversation.com/why-cholera-continues-to-threaten-many-african-countries-197799">Malawi</a>; malaria and tuberculosis are among them. </p>
<p>These diseases do not respect <a href="https://theconversation.com/how-africas-porous-borders-make-it-difficult-to-contain-ebola-118719">human-made or porous borders</a>. So it’s essential that scientists in Africa are able to generate and share critical data on the pathogens in time to inform public-health decisions.</p>
<p>Genomic sequencing technologies are powerful tools in this kind of work. They enable scientists to decode the genetic material of diseases and create biological “fingerprints” to investigate and track the pathogens that cause those diseases. This information aids in developing diagnostics, treatments and vaccines. It also helps public health authorities to guide and prepare their public health systems for effective outbreak detection and response.</p>
<p>Tackling infectious diseases across countries and continents requires many complex, overlapping and broad interventions. One of those is a common repository where countries, public health authorities and their scientists can share information about diseases and the pathogens that cause them. They can then collaborate around the shared data. These <a href="https://www.insdc.org/">kinds of platforms</a> exist in many high-income countries. But the African region lags behind.</p>
<p>This is set to change. In a <a href="https://www.nature.com/articles/s41591-023-02266-y">new publication</a> in Nature Medicine we outline the work that’s being done to create such a repository for the African continent. </p>
<h2>Human and economic costs</h2>
<p>Africa accounts for <a href="https://www.sciencedirect.com/science/article/pii/S0092867420312381#cebib0010">most of the estimated 10 million deaths</a> caused globally every year by infectious diseases. </p>
<p>Those diseases also stomp the brakes on the continent’s development ambitions: according to a World Health Organisation (WHO) report they account for an <a href="https://www.afro.who.int/publications/heavy-burden-productivity-cost-illness-africa">annual estimated productivity loss</a> of US$800 billion. </p>
<p>These figures highlight the urgency of improving the scientific response to infectious diseases. </p>
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Read more:
<a href="https://theconversation.com/investing-in-health-systems-is-the-only-way-to-stop-the-next-ebola-outbreak-124957">Investing in health systems is the only way to stop the next Ebola outbreak</a>
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<p>There are some green shoots. The COVID pandemic showed what African institutions are capable of. The Africa Centres for Disease Control (Africa CDC), through the <a href="https://ipg.africacdc.org/initiatives/africa-pathogen-genomics-initiative-africa-pgi">Africa Pathogen Genomics Initiative</a>, oversaw the <a href="https://africacdc.org/news-item/africa-cdc-ramps-up-training-on-sars-cov-2-genomics-and-bioinformatics/">training</a> of hundreds of laboratory staff.</p>
<p>DNA sequencing machines and essential laboratory consumables – like reagents, the chemical cocktails that make testing possible – have been <a href="https://www.sciencedirect.com/science/article/pii/S1473309920309397">put in place</a>. Today, public health laboratories in many African countries, with varying levels of capacity, can generate their own genomic sequences of pathogens. </p>
<p>So, the data is not the problem. The questions are: what is going to happen to and with it? How and where is it going to be secured, and by whom? Will it be, as has been the <a href="https://theconversation.com/global-health-still-mimics-colonial-ways-heres-how-to-break-the-pattern-121951">custom up to now</a>, “exported” and the intellectual property moved offshore?</p>
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<a href="https://theconversation.com/how-biobanks-can-help-improve-the-integrity-of-scientific-research-100035">How biobanks can help improve the integrity of scientific research</a>
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<p>Global data sharing platforms have played a significant role in sharing of data. However, <a href="https://www.science.org/content/article/invented-persona-behind-key-pandemic-database">transparency and governance issues</a> are currently being raised by the global community.</p>
<p>Since 2020, the Africa CDC in collaboration with the <a href="https://aslm.org/">African Society for Laboratory Medicine</a>, the <a href="https://www.uwc.ac.za/study/all-areas-of-study/institutes/south-african-national-bioinformatics-institute/overview">South African National Bioinformatics Institute</a> and several public health institutions across Africa are working to develop a continental platform for pathogen genomic data management and sharing. The technology innovation and development involves <a href="https://hominum.global/">industry</a> and other <a href="http://nzconline.co.za">partners</a>.</p>
<p>The development of such a platform is not merely a technical exercise, though. An ecosystem must be created for its adoption. So it is being built in parallel with a consultation led by the Africa CDC with its member states, to refine data sharing agreements between countries and support national data governance frameworks.</p>
<p>The platform rests on six pillars.</p>
<h2>Collaboration and consistency</h2>
<p>The first pillar is adoption and change management. Regional organisations – those that drove training and infrastructure investment during the COVID-19 pandemic – must drive the development of the necessary policies, processes and system changes across the continent.</p>
<p>Second, the platform must offer a good user experience that will allow for seamless, cost-effective data collection and the timely sharing and use of data across Africa.</p>
<p>Third, we need data services and products to facilitate the sharing of data and information with decision-makers who are not scientists or geneticists. </p>
<p>Fourth, standardised and consistent data management processes, practices, tools and controls for how data is processed, stored, shared and deployed are needed across countries and contexts. </p>
<p>Core infrastructure is the fifth pillar: the technical side of the platform must be composed of application and infrastructure components that can be rapidly reconfigured for contexts and diseases. </p>
<p>And, finally, good programme management and sustainable resources will be key.</p>
<h2>A global imperative</h2>
<p>As we argue in <a href="https://www.nature.com/articles/s41591-023-02266-y">our journal article</a>, data management and analytics to support data-driven decision making in public health is a global imperative. It requires continuous engagement with international disease surveillance stakeholders and technology platform developers.</p>
<p>The human and resource costs of unchecked diseases in Africa have been pointed out. If there is going to be a collective response to Africa’s burden of diseases – and it is a massive task – a shared pathogen genomics data platform would be a crucial step in underpinning those efforts.</p>
<p>An African owned and African led data sharing platform will be critical for timely sharing of locally produced data to inform rapid response to outbreaks. It will also be a critical step towards an equitable mechanism to maximise the value and utility of pathogen genetic data for national, regional and global health security.</p><img src="https://counter.theconversation.com/content/204284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Christoffels receives funding from the South African Medical Research Council, The South African National Research Foundation and the Bill & Melinda Gates Foundation. The partners in this repository development project are the Public Health Alliance for Genomic Epidemiology, the Overture.bio team at the Ontario institute for Cancer Research in Canada, the Centre for High Performance Computing at the CSIR, South Africa, and Hominum Global.</span></em></p><p class="fine-print"><em><span>Sofonias Kifle Tessema does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Time and information is of the essence when tackling infectious diseases across countries and continents.Alan Christoffels, Director South African National Bioinformatics Institute, University of the Western CapeSofonias Kifle Tessema, Program Lead for Pathogen Genomics at the Africa CDCLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2004862023-03-13T12:26:20Z2023-03-13T12:26:20ZMarburg virus outbreaks are increasing in frequency and geographic spread – three virologists explain<figure><img src="https://images.theconversation.com/files/514041/original/file-20230307-20-6vacw1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2100%2C2190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Marburg virus spreads through close contact with infected body fluids.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/QPbCNb">NIAID/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The World Health Organization confirmed an <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON444">outbreak of the deadly Marburg virus disease</a> in the central African country of Equatorial Guinea on Feb. 13, 2023. To date, there have been <a href="https://www.rfi.fr/en/international-news/20230228-death-toll-in-e-guinea-marburg-outbreak-rises-to-11">11 deaths suspected to be caused by the virus</a>, with one case confirmed. Authorities are currently monitoring 48 contacts, four of whom have developed symptoms and three of whom are hospitalized as of publication. The WHO and the U.S. Centers for Disease Control and Prevention are assisting Equatorial Guinea in its efforts to stop the spread of the outbreak.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of Marburg virus particles" src="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1053&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1053&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514050/original/file-20230307-16-7oenhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1053&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Marburg virus is structurally similar to the Ebola virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/marburg-virus-is-a-hemorrhagic-fever-virus-first-described-news-photo/1035562466">Photo12/Universal Images Group via Getty Images</a></span>
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<p><a href="https://doi.org/10.3390/v4101878">Marburg virus</a> and the <a href="https://doi.org/10.12688/f1000research.17573.1">closely related</a> Ebola virus belong to the <a href="https://doi.org/10.1016/j.jmb.2019.06.029">filovirus family</a> and are <a href="https://doi.org/10.1007/82_2017_16">structurally</a> <a href="https://doi.org/10.3201%2Feid1008.040350">similar</a>. Both viruses cause severe disease and death in people, with fatality rates ranging from 22% to 90% <a href="https://www.cdc.gov/vhf/ebola/index.html">depending on</a> <a href="https://www.cdc.gov/vhf/marburg/index.html">the outbreak</a>. Patients infected by these viruses exhibit a <a href="https://doi.org/10.1016/j.ijid.2020.07.042">wide range of similar symptoms</a>, including fever, body aches, severe gastrointestinal symptoms like diarrhea and vomiting, lethargy and sometimes bleeding.</p>
<p>We are <a href="https://scholar.google.com/citations?user=rUT_g04AAAAJ&hl=en&oi=ao">virologists</a> <a href="https://scholar.google.com/citations?hl=en&user=j9jTdBsAAAAJ">who</a> <a href="https://scholar.google.com/citations?user=PdTPtc8AAAAJ&hl=en&oi=ao">study</a> Marburg, Ebola and related viruses. <a href="https://www.bu.edu/muhlbergerlab/">Our laboratory</a> has a long-standing interest in researching the underlying mechanisms of how these viruses cause disease in people. Learning more about how Marburg virus is transmitted from animals to humans and how it spreads between people is essential to preventing and limiting future outbreaks. </p>
<h2>Marburg virus disease</h2>
<p>Marburg virus spreads between people by close contact only after they show symptoms. It is transmitted through <a href="https://doi.org/10.1016/j.ijid.2020.07.042">infected body fluids</a> such as blood, and is not airborne. Contact tracing is a potent tool to combat outbreaks. The incubation time, or time between infection and the onset of symptoms, ranges from two to 21 days and typically falls between five and 10 days. This means that contacts must be observed for extended periods for potential symptoms. </p>
<p>Marburg virus <a href="https://doi.org/10.1093/infdis/jir299">cannot be detected before patients are symptomatic</a>. One major cause of the spread of Marbug virus disease is <a href="https://doi.org/10.3201/eid0912.030355">postmortem transmission</a> due to traditional burial procedures, where family and friends typically have direct skin-to-skin contact with people who have died from the disease.</p>
<p>There are currently no approved <a href="https://doi.org/10.1016/j.ijid.2020.07.042">treatments</a> or <a href="https://doi.org/10.1016/j.vaccine.2020.11.042">vaccines</a> against Marburg virus disease. The most advanced vaccine candidates in development use strategies that <a href="https://doi.org/10.1016/j.ebiom.2023.104463">have been shown</a> <a href="https://doi.org/10.3390/vaccines10101582">to be effective</a> at <a href="https://doi.org/10.1126/scitranslmed.abq6364">protecting against</a> <a href="https://doi.org/10.1016/S0140-6736(22)02400-X">Ebola virus disease</a>. </p>
<p>Without effective treatments or vaccines, Marburg virus <a href="https://doi.org/10.1086/520548">outbreak control</a> primarily relies on contact tracing, sample testing, patient contact monitoring, quarantines and attempts to limit or modify high-risk activities such as <a href="https://doi.org/10.1086/520544">traditional funeral practices</a>.</p>
<h2>What causes Marburg virus outbreaks?</h2>
<p>Marburg virus outbreaks have an unusual history. </p>
<p>The <a href="https://doi.org/10.1086/520551">first recorded outbreak</a> of Marburg virus disease occurred in Europe. In 1967, laboratory workers in Marburg and Frankfurt in Germany, as well as in Belgrade, Yugoslavia (now Serbia) were <a href="https://doi.org/10.1136/pgmj.49.574.542">infected with a previously unknown pathogen</a> after handling infected monkeys that had been imported from Uganda. This outbreak led to the <a href="https://doi.org/10.1086/520551">discovery of the Marburg virus</a>.</p>
<p>Identifying the virus took only three months, which, at the time, was incredibly fast considering the available research tools. Despite receiving intensive care, <a href="https://doi.org/10.1086/520551">seven of the 32 patients died</a>. This case fatality rate of 22% was relatively low compared to subsequent Marburg virus outbreaks in Africa, which have had a <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">cumulative case fatality rate of 86%</a>. It remains unclear if these differences in lethality are due to variability in patient care options or other factors such as distinct viral strains.</p>
<p>Subsequent Marburg virus disease outbreaks occurred in Uganda and Kenya, as well as the Democratic Republic of the Congo and Angola in Central Africa. In addition to the current outbreak in Equatorial Guinea, recent Marburg virus cases in the West African countries of Guinea in 2021 and Ghana in 2022 highlight that the Marburg virus is <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">not confined to Central Africa</a>.</p>
<p>Strong evidence shows that the <a href="https://doi.org/10.1371/journal.ppat.1000536">Egyptian fruit bat</a>, a natural animal reservoir of Marburg virus, might play an important role in spreading the virus to people. The location of all Marburg virus outbreaks coincides with the <a href="https://www.iucnredlist.org/species/29730/22043105">natural range of these bats</a>. The large area of Marburg virus outbreaks is unsurprising, given the <a href="https://doi.org/10.3390/v4101878">ecology of the virus</a>. However, the mechanisms of zoonotic, or animal-to-human, spread of Marburg virus still remain poorly understood.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Researchers approaching Bat Cave in Queen Elizabeth National Park" src="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514042/original/file-20230307-16-m3dkhs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A number of Marburg virus outbreaks are linked to human activity in caves where Egyptian fruit bats are known to roost.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jennifer-mcquiston-jonathan-towner-and-brian-amman-approach-news-photo/1073367830">Bonnie Jo Mount/The Washington Post via Getty Images</a></span>
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<p>The origin of a number of Marburg virus disease outbreaks is closely linked to human activity in caves where Egyptian fruit bats roost. More than half of the cases in a 1998 outbreak in the northeastern Democratic Republic of the Congo were among <a href="https://doi.org/10.1056/NEJMoa051465">gold miners who had worked in Goroumbwa Mine</a>. Intriguingly, the end of the nearly two-year outbreak coincided with the flooding of the cave and the disappearance of the bats in the same month.</p>
<p>Similarly, in 2007, four men who <a href="https://doi.org/10.1093/infdis/jir312">worked in a gold and lead mine</a> in Uganda where thousands of bats were known to roost became infected with Marburg virus. In 2008, two tourists were infected with the virus after visiting <a href="https://www.cdc.gov/cdctv/diseaseandconditions/outbreaks/uganda-python-cave.html">Python Cave</a> in the Maramagambo Forest in Uganda. Both developed severe symptoms after returning to their home countries – the <a href="https://doi.org/10.3201%2Feid1508.090051">woman from the Netherlands died</a> and the <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm">woman from the United States survived</a>.</p>
<p>The <a href="https://www.iucnredlist.org/species/29730/22043105">geographic range of Egyptian fruit bats</a> extends to large portions of sub-Saharan Africa and the Nile River Delta, as well as portions of the Middle East. There is potential for <a href="https://theconversation.com/what-is-spillover-bird-flu-outbreak-underscores-need-for-early-detection-to-prevent-the-next-big-pandemic-200494">zoonotic spillover events</a>, to occur in any of these regions.</p>
<h2>More frequent outbreaks</h2>
<p>Although Marburg virus disease outbreaks have historically been sporadic, their <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">frequency has been increasing</a> in recent years. </p>
<p>The increasing emergence and reemergence of zoonotic viruses, including filoviruses (such as <a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola</a>, <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7145a5.htm">Sudan</a> and <a href="https://www.cdc.gov/vhf/marburg/index.html">Marburg</a> viruses), coronaviruses (which cause <a href="https://www.cdc.gov/sars/index.html">SARS</a>, <a href="https://www.cdc.gov/coronavirus/mers/index.html">MERS</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">COVID-19</a>), henipaviruses (such as <a href="https://www.cdc.gov/vhf/nipah/index.html">Nipah</a> and <a href="https://www.cdc.gov/vhf/hendra/index.html">Hendra</a> viruses) and <a href="https://www.cdc.gov/poxvirus/mpox/index.html">Mpox</a> appear to be influenced by both <a href="https://doi.org/10.1038/s41586-022-05506-2">human encroachment</a> on previously undisturbed animal habitats and alterations to wildlife habitat ranges <a href="https://doi.org/10.1038/s41586-022-04788-w">due to climate change</a>. </p>
<p>Most Marburg virus outbreaks have occurred in remote areas, which has helped to contain the spread of the disease. However, the large geographic distribution of Egyptian fruit bats that harbor the virus raises concerns that future Marburg virus disease outbreaks could happen in new locations and spread to more densely populated areas, as seen by the devastating <a href="https://doi.org/10.1007/82_2017_69">Ebola virus outbreak in 2014 in West Africa</a>, where <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">over 11,300 people died</a>.</p><img src="https://counter.theconversation.com/content/200486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elke Mühlberger receives funding from NIH/NIAID, the Bill and Melinda Gates Foundation, the Howard Hughes
Medical Institute (as coinvestigator on Emerging Pathogens Initiative project). </span></em></p><p class="fine-print"><em><span>Adam Hume and Judith Olejnik do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Marburg virus, a close cousin of Ebola, currently has no approved treatments or vaccines to protect against it.Adam Hume, Research Assistant Professor of Microbiology, Boston UniversityElke Mühlberger, Professor of Microbiology, Boston UniversityJudith Olejnik, Senior Research Scientist, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000822023-02-17T04:00:40Z2023-02-17T04:00:40ZWhat is Marburg virus and should we be worried?<figure><img src="https://images.theconversation.com/files/510752/original/file-20230217-28-im18ez.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3494%2C2839&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/search/marburg-virus">Shutterstock</a></span></figcaption></figure><p>An epidemic outbreak of Marburg virus in Equatorial Guinea, Central Africa, was <a href="https://www.afro.who.int/countries/equatorial-guinea/news/equatorial-guinea-confirms-first-ever-marburg-virus-disease-outbreak">confirmed this week</a>, the first time the virus has occurred there. At least 16 cases have been detected, and <a href="https://www.abc.net.au/news/2023-02-15/marburg-virus-kills-nine-in-equatorial-guinea/101974932">nine deaths</a>.</p>
<p>There are no approved treatments for Marburg virus, which is closely related to Ebola virus, but <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02400-X/fulltext#%20">vaccines are in development</a>. Following an unprecedented Ebola epidemic in West Africa in 2014 that caused more than <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">28,000 cases and 11,000 deaths</a>, drugs and vaccines against Ebola were developed.</p>
<p>In fact, some of these were <a href="https://www.sciencedirect.com/science/article/pii/S0006291X20320878?via%3Dihub">repurposed for COVID-19</a> in 2020. That experience may help more rapid vaccine and drug development against Marburg virus. </p>
<h2>What is Marburg virus?</h2>
<p>Marburg is a <a href="https://www.cdc.gov/vhf/virus-families/filoviridae.html">filovirus</a> like its more famous cousin, Ebola. These are part of a broader group of viruses that can cause viral haemorrhagic fever, a syndrome of fever and bleeding. </p>
<p>Filoviruses are the most lethal of all haemorrhagic fevers, compared with more common viral haemorrhagic fevers such as dengue, yellow fever and Lassa fever. The <a href="https://www.cdc.gov/vhf/marburg/index.html">first outbreaks</a> of Marburg occurred in 1967 in lab workers in Germany and Yugoslavia who were working with African green monkeys imported from Uganda. The virus was identified in a lab in Marburg, Germany. </p>
<p>Since then, outbreaks have occurred in a handful of countries in Africa, less frequently than Ebola, with the largest in Angola in 2005 (<a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">374 cases and 329 deaths</a>).</p>
<p>Marburg’s natural host is a fruit bat, but it can also infect primates, pigs and other animals. Human outbreaks start after a person has contact with an infected animal.</p>
<p>It’s spread between people mainly through direct contact, especially with bodily fluids, and it causes an illness like Ebola, with fever, headache and malaise, followed by vomiting, diarrhoea, and aches and pains. The bleeding follows about five days later, and it can be <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">fatal in up to 90% of people infected</a>.</p>
<h2>How worried should we be?</h2>
<p>Like Ebola in 2014, the fear is that Marburg could spread and become a much larger epidemic, and spread globally. Travel could see it spread to many other countries. In 2014, Ebola cases spread from Guinea to Liberia and Sierra Leone. The majority of cases occurred in these three countries, but travel-related cases occurred in <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">seven other countries</a> including the United States and the United Kingdom. </p>
<p>If Marburg case numbers increase in Equatorial Guinea or in <a href="https://www.9news.com.au/world/marburg-virus-suspected-cases-in-cameroon/3a86e700-d313-406b-8210-243d5020641e">Cameroon</a>, where it has already spread, or if it spreads to other countries, all countries should be on alert. </p>
<p>Failure to diagnose viral haemorrhagic fever in countries not familiar with it can be deadly. The diagnosis of Ebola was <a href="https://www.nbcnews.com/storyline/ebola-virus-outbreak/nurse-who-caught-ebola-settles-suit-against-dallas-hospital-n672081">initially missed in a traveller from West Africa</a> in Dallas, Texas at the peak of the epidemic in 2014, and a nurse became infected. In Nigeria, the same thing occurred, but resulted in an <a href="https://www.abc.net.au/news/2014-10-20/who-declares-ebola-defeated-in-nigeria/5828414">outbreak and several deaths</a>.</p>
<p>Less is known about Marburg virus than Ebola, which was well-studied during the large 2014 epidemic. It <a href="https://www.medrxiv.org/content/10.1101/2022.06.17.22276538v2">may be less infectious than Ebola</a>, but there are fewer epidemics to assess this. </p>
<p>However, the high fatality rate, lack of available treatments and vaccines, and lessons from Ebola in 2014 should prompt a highly precautionary approach.</p>
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<a href="https://theconversation.com/how-are-nurses-becoming-infected-with-ebola-32873">How are nurses becoming infected with Ebola?</a>
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<h2>How to stop its spread</h2>
<p>While researchers will <a href="https://www.nature.com/articles/d41586-023-00468-5">trial Marburg vaccines</a> currently in development against this epidemic, non-phamaceutical measures are the best hope for controlling the epidemic rapidly. That means excellent surveillance and case detection, finding and isolating sick people, tracing their contacts, and quarantine of contacts to prevent transmission. </p>
<p>The infrastructure and planning for this can be substantial, including physical sites for isolation and quarantine. During the Ebola epidemic in Nigeria, a rapid and effective response included <a href="https://www.bellanaija.com/2014/09/must-read-through-the-valley-of-the-shadow-of-death-dr-ada-igonoh-survived-ebola-this-is-her-story/">use of an abandoned building</a> to isolate and treat patients rather than risk further hospital outbreaks.</p>
<p>The importance of identifying and isolating cases was seen in West Africa in 2014, where lack of hospital beds resulted in people dying in the street and worsening spread. <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm#:%7E:text=Extrapolating%20trends%20to%20January%2020,when%20corrected%20for%20underreporting)%20(Appendix**)">One study</a> found if 70% or more of infected people were isolated in a hospital bed, the epidemic could have been controlled without any drugs or vaccines. However it was very late in the epidemic when field hospitals were erected to overcome hospital bed shortages.</p>
<p>Use of <a href="https://www.sciencedirect.com/science/article/pii/S0020748914003319?via%3Dihub">personal protective equipment</a> is also crucial, especially for health workers who are at <a href="https://academic.oup.com/jid/article/218/suppl_5/S679/5091974">increased risk</a> of filovirus infections. Disinfection and safe disposal of <a href="https://medicalguidelines.msf.org/en/viewport/CG/english/viral-haemorrhagic-fevers-16690024.html">biological waste</a> is also important. Funerals where washing of the body is a cultural practice can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709130/">spread infection</a>.</p>
<p>Health promotion and effective, culturally appropriate communication is needed to ensure compliance with health measures. During the Ebola epidemic in 2014, a team of people trying to raise awareness about Ebola were <a href="https://www.bbc.com/news/world-africa-29256443">killed by locals</a> who were fearful of the epidemic and mistrusting of foreigners. These lessons must be heeded if the Marburg epidemic grows.</p>
<p>Both Marburg and Ebola can <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004475">persist in the body</a> after recovery, in organs and fluids including seminal and vaginal fluid, the eye and other sites. This means <a href="https://www.ijidonline.com/article/S1201-9712(15)00292-1/fulltext">outbreaks originating from human survivors</a>, rather than from animals, are possible. </p>
<p>For low-income countries with weak surveillance systems, rapid <a href="https://www.epiwatch.org/">epidemic intelligence</a> using open-source data can help detect signals early. This is where news reports, social media and other data are used to look for patterns that could signify outbreaks of certain diseases in certain areas. We showed we could detect Ebola in the West African epidemic months earlier by <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230322">analysing Twitter posts</a> talking about disease symptoms in the area.</p>
<p>If the current epidemic continues to spread and is poorly controlled, the World Health Organization may declare a “Public Health Emergency of International Concern”, as it did with an <a href="https://theconversation.com/why-the-drc-ebola-outbreak-was-declared-a-global-emergency-and-why-it-matters-121991">Ebola epidemic in 2019</a> in the Democratic Republic of Congo. </p>
<p>For now, we have knowledge and experience of a poorly controlled, catastrophic epidemic of Ebola in 2014 that can inform the response to this epidemic of Marburg virus and hopefully control it quickly.</p>
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<a href="https://theconversation.com/how-would-australian-hospitals-respond-to-a-case-of-ebola-33203">How would Australian hospitals respond to a case of Ebola?</a>
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<img src="https://counter.theconversation.com/content/200082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC and MRFF and leads EPIWATCH, an AI-driven system for rapid epidemic warning signals.</span></em></p>There has been an epidemic outbreak of Marburg virus in Equatorial Guinea for the first time. Here’s what you need to know about the virus, and how it spreads.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1949242022-11-21T13:10:17Z2022-11-21T13:10:17ZEbola: Uganda’s schools were closed for two years during COVID, now they face more closures – something must change<figure><img src="https://images.theconversation.com/files/496121/original/file-20221118-24-tji913.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Extended school closures during the pandemic set Ugandan children far behind their peers.</span> <span class="attribution"><span class="source">BADRU KATUMBA/AFP via Getty Images</span></span></figcaption></figure><p>Children in Uganda missed out on more school because of the COVID pandemic than their peers anywhere else in the world. An estimated <a href="https://www.aljazeera.com/news/2022/1/10/ugandan-children-back-to-school-after-nearly-2-year-covid-closure">15 million pupils</a> in the East African nation did not attend school for 83 weeks – that’s almost two years. Statistical models predict a <a href="https://www.sciencedirect.com/science/article/pii/S073805932100050X?via%3Dihub">learning deficit of 2.8 years</a> in Uganda because of the time lost through COVID-related closures.</p>
<p>Now the education system has been hit by another public health emergency. In early November the government <a href="https://www.npr.org/sections/goatsandsoda/2022/11/10/1135619132/uganda-ends-school-year-early-as-it-tries-to-contain-growing-ebola-outbreak">announced</a> that preschools, primary and secondary schools must close their doors for the year ten days earlier than planned. This is part of its attempt to contain an <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON421">Ebola outbreak</a> which had, by 16 November, <a href="https://africacdc.org/disease-outbreak/outbreak-brief-8-sudan-ebola-virus-disease-evd-in-uganda/">killed 55 people</a>; <a href="https://www.monitor.co.ug/uganda/news/national/ebola-kills-8-children-as-infections-rise-in-schools-4013716">eight were children</a>.</p>
<p>Of course, it’s crucial for Uganda to try and stop Ebola from spreading. The disease has a far higher fatality rate than COVID. The country’s packed classrooms and poor school infrastructure, such as poor ventilation and sanitation, make students highly vulnerable to infections.</p>
<p>But young Ugandans have already fallen <a href="https://theconversation.com/uganda-closed-schools-for-two-years-the-impact-is-deep-and-uneven-176726">far behind</a> in their learning because of COVID. And, as the effects of climate change worsen, Africa is becoming increasingly vulnerable to health emergencies, including a number of infectious diseases. </p>
<p>That makes it incredibly important for Uganda to find a way to balance the realities of public health emergencies with children’s right to education. This is a particularly pressing issue in low-income contexts where many children struggle to complete their schooling even outside emergency situations.</p>
<h2>Kids are already far behind</h2>
<p>In a previous <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/chso.12627">study</a> emerging from a larger project called <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7654-8">CoVAC</a>(led by Karen Devries, Jenny Parkes and Dipak Naker), we outlined the many harms and losses Ugandan children and youth faced due to the prolonged closure of schools. </p>
<p>When schools finally reopened in January 2022, one in ten students <a href="https://www.unicef.org/uganda/press-releases/23-countries-yet-fully-reopen-schools-education-risks-becoming-greatest-divider">did not report back</a> to school. Some schools had <a href="https://www.theguardian.com/global-development/2022/jan/14/term-starts-in-uganda-but-worlds-longest-shutdown-has-left-schools-in-crisis">closed for good</a>. </p>
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<a href="https://theconversation.com/uganda-closed-schools-for-two-years-the-impact-is-deep-and-uneven-176726">Uganda closed schools for two years – the impact is deep and uneven</a>
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<p>The government tried to support distance learning through TV, radio, newspapers, downloadable curricula or, in some instances, via mobile phones. However, most interventions, in particular those that required access to a mobile phone or computer only benefited urban elites with the means to send their children to expensive private schools.</p>
<p>Almost all of the participants in our study had no or limited access to the resources needed to effectively engage with these materials. Girls in remote areas were especially disadvantaged, as they tended to have less access to mobile phones than boys.</p>
<p>Most of our study participants were not able to continue their schooling via distance learning. They eventually gave up on their education.</p>
<p>Homeschooling became a common practice in wealthier countries. But in Uganda it was a privilege reserved for only a few children from higher socio-economic backgrounds and expensive schools. The majority of Ugandan caregivers have to make an income in any way they can and often lack the time, space and resources to learn with their children at home.</p>
<p>Although schools will be only closed for a relatively short time, losing another ten days of learning may weaken the trust among Ugandans in the functioning of their educational institutions. Many Ugandans <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738059321000237?via%3Dihub">struggle to pay</a> for their children’s school fees and will question the real value of education in light of current and potentially more interruptions. </p>
<h2>Overhauling current model</h2>
<p>Uganda’s education sector needs to be strengthened so that disruptions caused by future health emergencies do not leave children even further behind in their schooling.</p>
<p>This will require an overhaul of how education is governed, implemented and made accessible during emergency situations. Uganda inherited its education system from its former British colonial administration. The appropriation of western and former colonial education systems by countries in sub-Saharan Africa has been questioned and critiqued by many, particularly <a href="https://link.springer.com/article/10.1007/s11159-016-9547-8">African scholars</a>. </p>
<p>Schooling, it is argued, was initially used as a tool by former colonisers to “<a href="https://ngugiwathiongo.com/decolonising-the-mind/">conquer the African mind</a>”. It ignored local culture and context with the intention to sustain colonial administration and nurture exploitative economic structures. </p>
<p>Today, part of the problem with adopting a universal model of schooling is that the <a href="https://www.sciencedirect.com/science/article/pii/S0305750X22002030?via%3Dihub">many flaws inherent in western-style education</a> are exacerbated in times of crisis. For instance, the model champions a form of schooling that is time and location bound. It does not easily adapt to <a href="https://www.tandfonline.com/doi/full/10.1080/13533312.2016.1214073">alternative forms of education</a> that allow for a more flexible mode of learning in the absence of a functioning school. </p>
<p>If adequately resourced and well implemented, alternative modes of learning during school closures can help the most vulnerable children and youth in their educational trajectories and overall well-being. This could be in the form of supporting distance learning in a different manner, such as the potential of outdoors teaching and learning where there is enough space for social distancing. Nearby teachers could be engaged to support locally organised, small learning groups of children in their respective communities. </p>
<p>Another option could be to ensure safe and continuous access to education in a staggered manner under strict hygienic measures. Investments in partnerships with local agencies and community-based organisations could help to facilitate radio, TV or internet-based learning spaces for children and youth with no access to learning technology.</p>
<h2>Urgent</h2>
<p>Some Ugandans told us that they fear schools will be closed for far longer than initially announced. This happened repeatedly during the COVID pandemic. It is also sadly likely that Ebola will not be the last epidemic the country must manage. </p>
<p>That’s why novel strategies and more resources are urgently needed to finally address deeply rooted social injustices in and outside education that arise before, during and after public health emergencies. Otherwise, children will be continuously at a high risk of dropping out of school, making them vulnerable to child labour or teenage pregnancies.</p><img src="https://counter.theconversation.com/content/194924/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simone Datzberger received funding for work referenced in this article from the European Commission Horizon 2020 programme (grant number 702880).
Funding for CoVAC research, referenced in this article, is provided by the Medical Research Council (grant number: MR/R002827/1).</span></em></p><p class="fine-print"><em><span>Musenze Junior Brian does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young Ugandans have already fallen far behind in their learning because of COVID.Simone Datzberger, Assistant Professor in Education and International Development, UCLMusenze Junior Brian, PhD Fellow, Makerere Institute of Social Research, Makerere UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1935722022-11-02T14:56:07Z2022-11-02T14:56:07ZEbola in Uganda: lessons from COVID show that heavy-handed lockdowns may be a bad idea<figure><img src="https://images.theconversation.com/files/492951/original/file-20221102-19-gkw3wm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Economic well-being is crucial to population health</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Since the first case of the current Ebola outbreak in Uganda was confirmed in mid-September, <a href="https://reliefweb.int/report/uganda/uganda-ebola-virus-disease-situation-report-no-37">the number of cases has topped 127</a> across seven districts, including 17 in the capital city Kampala. </p>
<p>Yet most people living in the city fear <a href="https://www.monitor.co.ug/uganda/news/national/lockdown-fuel-price-hike-fears-loom-large-4001622">another round of lockdowns</a> perhaps even more than they fear becoming infected.</p>
<p>Two high-risk districts are already <a href="https://www.npr.org/2022/10/16/1129342224/uganda-has-locked-down-two-districts-in-bid-to-stem-the-spread-of-ebola">under a 21-day lockdown</a>. And although the government says it is not considering Kampala high risk at the moment, it has not shied away from using <a href="https://www.monitor.co.ug/uganda/news/national/follow-sops-or-risk-lockdown-minister-3999588">the “threat” of lockdowns</a> to try to persuade people to conform to the health procedures. These include reporting suspected cases, supporting contact tracing and undergoing isolation where potential exposure to an infected person has taken place.</p>
<p>Fears about the impact of severe lockdown come against the backdrop of an economy that hasn’t recovered from the economic crisis associated with the COVID-19 pandemic, coupled with other global inflationary pressures. </p>
<p>This fear is warranted: a functioning economy, especially in highly vulnerable communities in urban areas, is crucial to population health. Blanket enforcement of lockdown measures may help to slow down the spread of a virus. But we now know that it can also quickly generate a larger and more protracted public health crisis in the form of deprivation and hunger.</p>
<p>I have been involved in a project, alongside <a href="https://khwaja.scholar.harvard.edu/">Asim Khwaja</a>, director of the Centre of International Development at Harvard University, and <a href="https://www.lse.ac.uk/school-of-public-policy/people/adnan-khan/adnan-khan">Adnan Khan</a>, professor at the London School of Economics and Political Science, to develop a more nuanced containment approach. We analysed different approaches adopted by countries across the globe during the COVID-19 pandemic. Based on our analysis we developed an approach we termed “<a href="https://www.theigc.org/wp-content/uploads/2020/05/Haas-et-al-2020-brief_final.pdf">Smart Containment with Active Learning</a>”.</p>
<p>This requires policy makers to find ways to handle a public health crisis without creating an economic one. Containment options must be informed by local conditions and suit varying circumstances. They should be reviewed and continuously updated with incoming data and evidence. </p>
<p>The approach we outline has implications for managing the current Ebola outbreak in Uganda as well as future health epidemics.</p>
<h2>The human cost of blanket lockdowns</h2>
<p>There is <a href="https://www.nytimes.com/2022/03/23/health/covid-africa-deaths.html?smid=nytcore-ios-share&referringSource=articleShare">no agreed explanation</a> about why the health impacts of COVID-19 were lower in some African countries, including Uganda, when compared against global rates. Still, the economic consequences, particularly of the lockdowns, were severe.</p>
<p>Researchers, using income data, have <a href="https://www.theigc.org/wp-content/uploads/2020/11/van-der-Ven-2020-Final-report.pdf">estimated</a> that economic losses across Uganda as a result of lockdowns were the equivalent of 9.1% of GDP. Over 65% of the population was affected and nearly ten years of poverty eradication efforts were erased.</p>
<p>The most extreme economic effects were felt in Kampala. Residents experienced <a href="https://www.theigc.org/wp-content/uploads/2020/11/van-der-Ven-2020-Final-report.pdf">an increase of 16.7 percentage points in poverty rates</a>. Income inequalities also rose, represented <a href="https://www.theigc.org/wp-content/uploads/2020/11/van-der-Ven-2020-Final-report.pdf">by a 10.5% increase in the GINI coefficient</a>. This was because many in the city could not earn a living at all for certain periods of time. </p>
<p>There are also likely to be long term effects on economic productivity, which remain to be seen. For example, Uganda <a href="https://www.ucl.ac.uk/news/2022/feb/opinion-uganda-closed-schools-two-years-impact-deep-and-uneven">closed schools for two years – the longest period</a> of any country. </p>
<p>It’s not yet possible to adequately quantify these losses. Nevertheless, <a href="https://www.oecd.org/education/The-economic-impacts-of-coronavirus-covid-19-learning-losses.pdf">based on evidence from school closures elsewhere</a>, this is likely to lead to a less skilled labour force and lower incomes. There are also likely to be significant associated social costs. </p>
<p>The reasons that Kampala fared worse than the national average lies in the overall structure of the city’s economy. In 2016 the World Bank <a href="https://datacatalog.worldbank.org/search/dataset/0041466">surveyed informal businesses</a> operating in the greater Kampala area. It showed that most businesses operated in the informal sector and were very small, with 46% employing fewer than five people.</p>
<p>Most importantly, 56% of owners said they engaged in trade and the services industry. And 93% of these microenterprise owners were, at the time of the survey, already operating close to the poverty line, or just beneath it. </p>
<p>When the lockdown was imposed, these businesses were no longer able to trade. Many of their owners and the households they supported would have been pushed far below the poverty line.</p>
<p>In urban areas like Kampala <a href="https://openknowledge.worldbank.org/handle/10986/25896">a high proportion of income</a> is used to buy food. The blanket lockdowns resulted in <a href="https://allianceforscience.cornell.edu/blog/2021/07/covids-second-wave-worsens-food-insecurity-in-east-africa/">17% of Kampala’s population </a> facing acute food insecurity and increased consumption gaps. </p>
<h2>Smart containment strategies</h2>
<p>The concern by the Ministry of Health in Uganda and the World Health Organization over the latest outbreak of Ebola in Uganda is warranted. The current strain of the virus circulating in Uganda, <a href="https://www.reuters.com/world/africa/uganda-health-ministry-confirms-ebola-outbreak-2022-09-20/">the so-called Sudan strain</a>, does not yet have an approved vaccine and has an estimated case fatality rate of 40%-60%. </p>
<p><a href="https://www.theigc.org/wp-content/uploads/2020/05/Haas-et-al-2020-brief_final.pdf">The 2014-2016 Ebola outbreak in West Africa</a> – caused by a different strain – resulted in 28,600 cases and 11,325 deaths. The case rate significantly increased once the virus hit the densely populated urban areas of Conakry, Freetown and Monrovia. </p>
<p>Containing the current outbreak, particularly in Kampala, is therefore critical.</p>
<p>But <a href="https://www.theigc.org/wp-content/uploads/2020/05/Haas-et-al-2020-brief_final.pdf">containment needs to be done in a smarter way</a> than was the case in the COVID pandemic. Contagion risks need to be weighed up against the benefits of maintaining economic interaction. </p>
<p>We conclude in our policy brief that containment doesn’t need to take an all-or-nothing approach. Gradations need to be considered.</p>
<p>Any smart containment strategy requires accurate and up-to-date data on disease prevalence, trends and transmission. And, critically, regular socio-economic data also need to be collected to assess growing risks, particular in relation to poverty and hunger. This data should then be used to drive the analysis that underpins the policy decisions about when, where and how to impose restrictions – and lift them. </p>
<p>These decisions should be taken in a more targeted and flexible way, below district level, to ensure that containment is commensurate to localised information, which, in turn, will be far less economically costly.</p>
<p>The second part of a smart containment strategy is that it needs to be dynamic, and changes should be made based on updated information. This is what we termed “active learning”. Here, again, data play a key role, in continuously assessing the risk profile of an area. </p>
<p>This does not only have to be geographical, but can also be related to different sectors. For example, interactions with high contagion risk and limited economic value, such as sporting events, may be fully shut down for a period, while in the same area, activities that support the livelihoods of vulnerable populations may continue, adapted to meet health and hygiene standards. </p>
<p>Finally, continuous evaluations of policy responses are important in supporting this active learning.</p>
<h2>Communication is key</h2>
<p>Underpinning such a strategy is <a href="https://www.nytimes.com/2015/01/31/opinion/how-bad-data-fed-the-ebola-epidemic.html?smid=nytcore-ios-share&referringSource=articleShare">clear, credible, transparent and regular
communication</a> on what is happening and why it is happening. There is evidence from Sierra Leone during the last Ebola outbreak that <a href="https://www.theigc.org/wp-content/uploads/2018/06/Maffioli-2018-Working-paper.pdf">effective messaging</a> that makes use of citizens’ agency and self-efficacy is key in securing community support for containment measures.</p>
<p>It’s also important that the messaging focuses on de-stigmatising individuals and minorities, so that those who are potentially infected feel comfortable taking proactive measures like self-isolating and seeking medical care. </p>
<p>In the longer term it helped increase trust in authorities, popular understanding, and support for further measures, unleashing a positive cycle that ultimately ended the epidemic.</p><img src="https://counter.theconversation.com/content/193572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Astrid R.N. Haas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lockdown measures may stop the spread of the virus. But they can also lead to a larger and more protracted public health crisis in the form of deprivation and hunger.Astrid R.N. Haas, Fellow, Infrastructure Institute, School of Cities, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915132022-10-26T14:06:04Z2022-10-26T14:06:04ZCOVID and health workers’ strike: how Kenya’s health services coped in times of crisis<figure><img src="https://images.theconversation.com/files/487735/original/file-20221003-20-6hjhxc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic and a health workers’ strike disrupted essential health services.</span> <span class="attribution"><span class="source">Donwilson Odhiambo/SOPA Images/LightRocket via Getty Images</span></span></figcaption></figure><p>When epidemics break out and public health emergencies are declared, people <a href="https://www.sciencedirect.com/science/article/pii/S0033350616303225?via%3Dihub">shy away</a> from seeking care for other conditions. This may seem counter-intuitive at first glance. But it makes sense. Ordinary life is disrupted, so visiting a clinic for a routine checkup becomes harder. People are afraid they’ll contract the virus or disease that’s driving the epidemic – especially in health facilities. </p>
<p>The results are predictably grim. </p>
<p>During the 2013-2014 Ebola outbreak in West Africa, the number of <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2016.00222/full">people seeking primary healthcare</a> for themselves and their children declined significantly. This resulted in an <a href="https://wwwnc.cdc.gov/eid/article/22/3/15-0977_article">increase in deaths</a> caused by malaria, HIV and tuberculosis (TB). The figures were <a href="https://www.sciencedirect.com/science/article/pii/S1473309915000614?via%3Dihub">similar to</a> – or in some cases greater than – the total number of deaths caused by the Ebola virus disease. </p>
<p>The COVID-19 pandemic appears to have followed the same worrying trajectory, at least in Kenya. We <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00285-6/fulltext">analysed</a> how the pandemic influenced the use of multiple healthcare services in the East African nation. Our study specifically aimed to assess which healthcare services were resilient to disruptions in the system and which ones were more vulnerable.</p>
<p>We collected monthly aggregates of county-level data for 17 indicators from the Kenya health information system across four periods. These were pre-pandemic (January 2018 to February 2020), two pandemic periods (March to November 2020 and February to October 2021) and the <a href="https://www.reuters.com/article/us-health-coronavirus-kenya-strike-idUSKBN28V12Q">healthcare workers’ strike</a> from December 2020 to January 2021. The indicators centred on four categories:</p>
<ul>
<li><p>outpatient visits to primary healthcare facilities </p></li>
<li><p>reproductive and child health (including antenatal care and children’s routine vaccinations) </p></li>
<li><p>sexual violence and communicable diseases (such as HIV tests conducted, and people tested for malaria and TB)</p></li>
<li><p>noncommunicable diseases (cervical cancer screening, and cases of hypertension and diabetes detected)</p></li>
</ul>
<p>We combined these data with information from Google and Facebook about human movement in Kenya during the pandemic period, as well as health ministry data about confirmed daily COVID-19 cases. We made note of curfews and other movement restrictions to ensure this was accounted for.</p>
<p>We found that the pandemic and the associated healthcare workers’ strike disrupted essential health services. Outpatient visits, screening and diagnostic services, and child immunisation were particularly negatively affected. </p>
<p>These findings are a valuable tool to help health authorities and other stakeholders prepare better for future pandemics and ensure that essential health services continue to operate as normally as possible even during abnormal times.</p>
<h2>Worrying declines and some bright spots</h2>
<p>Outpatient visits, screening and diagnostic services, as well as child vaccinations were hardest hit. </p>
<p>The onset of the pandemic was associated with significant declines in outpatient visits (29%), cervical cancer screening (50%) and number of HIV tests conducted (45%). The number of patients tested for malaria (32%), notified TB cases (27%), hypertension cases (10%) and vitamin A supplements (9%) also declined. And we saw drops in three doses of the diphtheria, tetanus toxoid and pertussis vaccine administered (1%). These may have been driven by the partial lockdowns, stay-home orders and restriction of movement, discouraging patients and parents from seeking non-emergency services. </p>
<p>At the beginning of the emergency when little was known about COVID-19, the health ministry issued directives around minimising crowding within hospitals, partly by reducing non-emergency clinic visits and surgeries. This may have reduced outpatient visits in addition to propagating the fear of contracting disease within hospitals.</p>
<p>For outbreaks such as Ebola, fear of contracting the virus in health settings has been shown to affect access to other health services negatively.</p>
<p>Access to antiretrovirals was not hit as hard as the other services. This could be due to a policy change by the <a href="https://www.nascop.or.ke/">national AIDS and sexually transmitted infections control programme</a> allowing for multi-month dispensing of antiretroviral drugs. This reduced the need for frequent clinic visits.</p>
<p>We also noticed fewer reported cases of pneumonia and diarrhoea in children. It is not clear if this was related to improved hygiene associated with handwashing or the decreased contact between children when schools closed. It could also be reduced reporting as a result of a change in healthcare seeking behaviour brought on by the pandemic.</p>
<p>One worrying <em>increase</em> in visits to essential healthcare facilities stemmed from cases of sexual violence, which increased by 8%. Gender-based violence is <a href="https://www.unwomen.org/en/news/in-focus/in-focus-gender-equality-in-covid-19-response/violence-against-women-during-covid-19">associated</a> with stress, uncertainty, social isolation and movement restrictions. </p>
<p>There were some promising data points. The rates of skilled deliveries for pregnancy, as well as those for antenatal care (care during pregnancy) were resilient. They remained steady both at the outset of and during the pandemic. </p>
<p>There are several possible reasons for this. Permits were issued to expectant mothers so they could visit healthcare centres during curfew hours. An ambulance system, <a href="https://khf.co.ke/w4l/">Wheels of Life</a>, was designated in Nairobi to transport pregnant women during curfew hours. Strong guidelines were also issued to facilities about the continuity of reproductive and maternal health services. And many pregnant women remained committed to giving birth in hospital because they had arranged antenatal care and delivery before the pandemic.</p>
<p>Towards the later stages of the pandemic, most health indicators started to recover. But the healthcare workers’ strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike period, except for the number of notified tuberculosis cases, which increased slightly by 0·3%.</p>
<h2>Recommendations</h2>
<p>There is little use in trying to improve essential health services when a pandemic has already begun. Preparedness is key. Kenya must – with data sets like ours, among other tools – identify which services are vulnerable in times of crisis. These should then be improved so that human life is protected before, during and after a health emergency.</p>
<p>Health authorities should also be developing and disseminating guidelines to healthcare managers so they know how best to manage services both during and outside a crisis. Better coordination and communication between county and national departments is crucial, too.</p>
<p>And there are lessons to be learned from resilient indicators. We must examine what made maternal health indicators remain robust during the health crisis and how those interventions might be applied in different areas of the healthcare system.</p><img src="https://counter.theconversation.com/content/191513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Loice Achieng Ombajo receives funding from
CDC, BMGF, WHO, UKAID through the Fleming Fund and
funds for investigator initiated clinical trials from ViiV HealthCare and Gilead Sciences</span></em></p><p class="fine-print"><em><span>Thumbi Mwangi receives funding from the BMGF, German DFG, USAID, NIH. </span></em></p><p class="fine-print"><em><span>Helen Kiarie, Marleen Temmerman, and Mutono Nyamai do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Outpatient visits, screening and diagnostic services, and child immunisation were particularly negatively affected.Mutono Nyamai, Post-doctoral research scientist, Centre for Epidemiological Modelling and Analysis, University of NairobiLoice Achieng Ombajo, Infectious Disease Specialist, Senior Lecturer in Internal Medicine, Co-director of the Center for Epidemiological Modelling and Analysis, University of NairobiMarleen Temmerman, Director of the Centre of Excellence in Women and Child Health and Chair of the Department of Obstetrics and Gynaecology (OB/GYN), Aga Khan University Thumbi Mwangi, Co-Director, Center for Epidemiological Modelling and Analysis (CEMA), University of Nairobi. Chancellors Fellow, Institute of Immunonology and Infection Research, University of Edinburgh. Associate Professor, Paul G Allen School for Global Health, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1929752022-10-23T08:35:17Z2022-10-23T08:35:17ZEbola in Uganda: why women must be central to the response<figure><img src="https://images.theconversation.com/files/490859/original/file-20221020-15-uvpf97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women need to be involved at every level of decision-making.</span> <span class="attribution"><span class="source">Luke Dray/Getty Images</span></span></figcaption></figure><p><a href="https://academic.oup.com/ia/article-abstract/97/3/601/6180992">“No time for that”</a> was the constant refrain heard by gender and women’s health experts working in the 2014/16 Ebola response. This was an emergency and the main thing was to deal with the crisis. </p>
<p>It was the Guinea, Liberia and Sierra Leone outbreak of Ebola that signalled what was to come for women around the world in the COVID-19 outbreak. Quarantines saw a <a href="https://eca.unwomen.org/en/digital-library/publications/2020/07/spotlight-on-gender-covid-19-and-the-sdgs-0">rise</a> in domestic and intimate partner violence. Girls were <a href="https://www.amnesty.org/en/latest/news/2020/03/sierra-leone-discriminatory-ban-on-pregnant-girls/">banned from school</a> when they returned pregnant. Fear of health centres and hospitals and closures led to increases in other health issues. <a href="https://gh.bmj.com/content/1/3/e000065">More</a> women died from maternal mortality than from Ebola.</p>
<p>In early 2020 I worked with women around the world to raise the flag of <a href="https://eca.unwomen.org/en/digital-library/publications/2020/07/spotlight-on-gender-covid-19-and-the-sdgs-0">the potential gendered impact of COVID-19</a>. But few people wanted to listen. No time for that. As with Ebola, it is often only when the harm is done that people working on the response realise two crucial things. First, health emergencies do immediate and long term harm to women, disproportionately. And second, women are essential to responding to health emergencies.</p>
<p>Ebola outbreaks are scary. We’ve come along way from 2014/16 and the Ugandan government is doing all the right things – alerting the world, contact tracing, protecting frontline health workers, working with traditional healers, and working on communications to avert stigma. But there is a real risk that once again the issues that affect women and girls during a health emergency will be missed.</p>
<p>“Lessons learned” is a tired global health trope. But when it comes to the impact on women, we need to take action and here’s how.</p>
<h2>5 steps to take to centre women</h2>
<p>First, no-one likes lockdowns. But quarantines and lockdowns are specifically a feminist issue. They harm women and put an increased burden on their <a href="https://www.fawcettsociety.org.uk/the-impacts-of-coronavirus-on-women">time and labour</a>. If necessary, any quarantine measures should be accompanied by a full support package for vulnerable women. This means the government needs to be working with the women’s sector, particularly those working on violence against women from the onset – not as an afterthought. Any quarantine measures need to be met with full social and welfare support. International donors need to support the Ugandan government to make this work.</p>
<p>Second, women health workers tend to be <a href="https://www.who.int/activities/value-gender-and-equity-in-the-global-health-workforce">clustered</a> in community health work. This involves door-to-door work on information communication, care and contact tracing. During an Ebola outbreak this is high risk. Their personal protection equipment requirements need to be prioritised alongside medical professionals. Moreover, lots of community health workers are volunteers, yet they are the bedrock of finding information in the Ebola response. They need to be paid. Health workers need to be protected, not stigmatised or subject to violence.</p>
<p>Third, everyone involved in the Ebola response should have training to detect and report sexual exploitation and abuse, including the international community. We do not want a repeat of what happened in the Democratic Republic of Congo – what experts <a href="https://apnews.com/article/business-health-united-nations-world-health-organization-ebola-virus-36ceb41d266190d149a74e400332e1ed">called</a> the worst case of sexual exploitation and abuse in UN history – where 82 alleged perpetrators, 21 with direct links to the World Health Organisation, were accused of the abuse and exploitation of girls and women – as young as 13.</p>
<p>Health emergencies bring a mass influx of resources to a vulnerable situation: this is ripe territory for exploitation. Tackling abuse and exploitation should never be an afterthought; often thought about when it is too late. Instead, it should be addressed as an ever-present risk when responding to health emergencies.</p>
<p>Fourth, we need good data. During the Ebola outbreak in 2014/16 I developed the idea of women being <a href="https://www.tandfonline.com/doi/full/10.1080/01436597.2015.1108827">conspicuously invisible</a>. They were everywhere in frontline community health work – but were totally invisible in decision-making or official data. Data should detect not only where and how Ebola is spreading but who is most vulnerable. This means counting how many men and how many women are getting and dying of Ebola. Data informs what measures need to be put in place to help people. Sex disaggregated data is not perfect (most systems fail to account for non-binary people for example), but it is a start.</p>
<p>Finally, and I cannot stress this enough: women need to be involved at every level of decision-making. From the high profile <a href="https://twitter.com/JaneRuth_Aceng?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor">Jane Ruth Aceng</a>, Minister of Health in Uganda, to the contact tracing teams, to the surveillance squads. Women leaders do not necessarily mean greater representation of women’s issues or women friendly policies. However, given that the health sector is highly feminised, women must sit around the tables that matter.</p>
<h2>Learning from the past</h2>
<p>I’ve seen at first hand the harm that health emergencies did to women in Sierra Leone in the 2014/16 outbreak. </p>
<p>When I started shouting about it during the COVID-19 response, “No time for that” was accompanied by, “Where’s the evidence and data?”.</p>
<p>Thanks to tireless work and mobilisation of gender and global health experts around the world, we have the evidence that health emergencies harm women. Now we must act so that this does not happen again in Uganda.</p><img src="https://counter.theconversation.com/content/192975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Harman receives funding from The Leverhulme Trust.</span></em></p>As with Ebola, it is often only when the harm is done that people working on the response realise health emergencies disproportionately harm women.Sophie Harman, Professor of International Politics, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915182022-09-30T12:15:48Z2022-09-30T12:15:48ZEbola: what are the symptoms, how does it spread and where did it come from?<figure><img src="https://images.theconversation.com/files/487069/original/file-20220928-14-pusxan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Microscopic view of the Ebola virus
</span> <span class="attribution"><span class="source">jaddingt/Shutterstock</span></span></figcaption></figure><p><em>Uganda health authorities have declared an outbreak of Ebola disease. Ebola outbreaks <a href="https://www.cdc.gov/vhf/ebola/history/chronology.html">emerge periodically</a> in several African countries, most notably in the Democratic Republic of Congo (DRC). Public health expert Yap Boum, who has been involved in managing Ebola outbreaks in the past, answers some key questions about Ebola’s history, treatment, and how to keep safe.</em></p>
<h2>What are the origins of the virus?</h2>
<p>Ebola is an old and deadly disease that was discovered <a href="https://www.itg.be/E/the-discovery-of-and-research-on-the-ebola-virus">in 1976</a> near the Ebola river in northern DRC. The virus was named after the river. It was discovered by <a href="https://www.statnews.com/2016/07/14/history-ebola-peter-piot/">scientists</a> including Jean-Jacques Muyembe – a Congolese microbiologist and general director of the DRC <a href="https://inrb.net/index.php/apropos">Institut National pour la Recherche Biomedicale</a> – and researchers from the Institute of Tropical Medicine, including Stefaan Pattyn, Guido van der Groen and Peter Piot. </p>
<p>Professor Muyembe was called to the village of Yambuku in northern Zaire (now DRC) where a mysterious illness had broken out. He took a sample and <a href="https://www.itg.be/E/the-discovery-of-and-research-on-the-ebola-virus">sent it to</a> the Institute of Tropical Medicine laboratory in Belgium, where the virus was isolated.</p>
<p>Since then, there have been <a href="https://www.cdc.gov/vhf/ebola/history/chronology.html">five identified</a> Ebola virus strains, four of which are known to cause disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d'Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). </p>
<p>It’s a zoonotic disease (animal-borne) though the natural reservoir host of Ebola virus remains unknown. However, bats are <a href="https://www.cdc.gov/ncezid/stories-features/global-stories/ebola-reservoir-study.html#:%7E:text=Researchers%20believe%20that%20Ebola%20virus,has%20yet%20to%20be%20determined.">the most likely</a> reservoir.</p>
<h2>What are the symptoms of Ebola?</h2>
<p>While the signs and symptoms may appear between 2 and 21 days after contact with the virus, they usually appear between 8 and 10 days. </p>
<p>They are quite similar to many tropical diseases, especially malaria and typhoid fever, with which they share symptoms such as:</p>
<ul>
<li>fever</li>
<li>aches and pains, such as severe headache and muscle and joint pain</li>
<li>weakness and fatigue</li>
<li>sore throat</li>
<li>loss of appetite</li>
<li>abdominal pain</li>
<li>diarrhoea and vomiting</li>
<li>unexplained haemorrhaging, bleeding or bruising.</li>
</ul>
<p>The main differences appear in the late stages of infection. These symptoms might include red eyes, skin rash and hiccups.</p>
<h2>Can it be treated?</h2>
<p>The Ebola virus disease can now be treated. The <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1910993">PALM clinical trial</a> – implemented between 2018 and 2020 in the DRC – has evaluated four drug candidates. Two of them – Inmazeb and Ebanga – <a href="https://www.cdc.gov/vhf/ebola/treatment/index.html">were approved</a> by the US Food and Drug Administration in October and December 2020 to treat the Ebola virus disease caused by the Ebola virus. They are made available to patients by the World Health Organization (WHO) during Ebola outbreaks and aren’t available in the market. </p>
<p>Inmazeb is a combination of three monoclonal antibodies and Ebanga is a single monoclonal antibody. Monoclonal antibodies (often abbreviated as mAbs) are proteins produced in a lab or other manufacturing facility that act like natural antibodies to stop a germ such as a virus from replicating after it has infected a person.</p>
<p>Ebanga <a href="https://www.ebanga.com/">was isolated</a> from a human survivor of the 1995 Ebola outbreak in Kikwit in the DRC who maintained circulating antibodies against the Ebola virus for more than a decade after infection.</p>
<p>Without treatment the average case fatality rate is <a href="https://www.cdc.gov/vhf/ebola/treatment/index.html">approximately</a> 50%. But it has ranged from 25% to 90% in past outbreaks.</p>
<h2>Can it be prevented?</h2>
<p>People can be vaccinated against one strain, the Zaire Ebola virus. It became a preventable disease following the validation of one vaccine candidate during the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext"><em>Ca Suffit</em> Ebola clinical trial</a> in 2015 in Guinea. The Ebola vaccine rVSV-ZEBOV (called Ervebo®) was approved by the US Food and Drug Administration in December 2019. This vaccine is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">given as</a> a single dose vaccine and has been found to be safe and protective with a reported 100% efficacy.</p>
<p>Though it has not yet been approved by the US Food and Drug Administration, Johnson & Johnson has a two-dose vaccine for the Zaire strain that was used under emergency use in 2019 during an Ebola outbreak in the DRC. This vaccine requires an initial dose and a “booster” dose 56 days later and could be made available through the WHO during outbreaks. </p>
<h2>How can you protect yourself?</h2>
<p>Ebola is a highly transmissible disease but, aside from vaccination for the Zaire strain, its spread can be prevented through behavioural measures.</p>
<p>People should avoid contact with blood and body fluids – such as urine, faeces, saliva, sweat, vomit, breast milk, amniotic fluid, semen and vaginal fluids – of people who are sick. People should also avoid contact with their personal items which might have traces of these fluids. </p>
<p>People who were previously infected <a href="https://theconversation.com/ebola-survivors-can-pass-on-the-virus-were-trying-to-understand-what-role-sex-plays-124015">can still carry</a> the disease in their semen. </p>
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<strong>
Read more:
<a href="https://theconversation.com/ebola-survivors-can-pass-on-the-virus-were-trying-to-understand-what-role-sex-plays-124015">Ebola survivors can pass on the virus: we're trying to understand what role sex plays</a>
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<p>Because it’s a zoonotic disease – that is, transmitted from animal to humans – people should avoid contact with bats, forest antelopes, nonhuman primates (such as monkeys and chimpanzees) and wild meat and blood especially in endemic areas.</p>
<p>Lastly, funeral or burial practices that involve touching the body of someone who may have died from Ebola should be avoided. Experience in West Africa shows these burial practices to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779538/">among the super spreaders</a> of the Ebola virus. </p>
<p>Ebola virus disease is a deadly disease that is preventable and curable. The next step is the local production of diagnostics, vaccines and drugs to ensure that endemic countries control their own stock and can make them available to their population. Africa can’t be left behind once more when it comes to diagnostics, vaccines and treatment, as it has been during the COVID pandemic and monkeypox outbreaks.</p><img src="https://counter.theconversation.com/content/191518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yap Boum does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ebola is a highly transmissible disease but its spread can be prevented through behavioural measures.Yap Boum, Professor in the faculty of Medicine, Mbarara University of Science and TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915062022-09-29T14:13:28Z2022-09-29T14:13:28Z5 steps to stop Ebola spreading in East Africa – a frontline expert advises<figure><img src="https://images.theconversation.com/files/487036/original/file-20220928-16-2bwv9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Staff from South Sudan's Health Ministry pose with protective suits during a drill for Ebola preparedness.</span> <span class="attribution"><span class="source">Photo by PATRICK MEINHARDT/AFP via Getty Images</span></span></figcaption></figure><p>The biggest Ebola outbreak in human history happened in <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html#:%7E:text=On%20March%2023%2C%202014%2C%20the,epidemic%2C%20the%20largest%20in%20history.">West Africa</a> from 2014 to 2015. I was on the front lines in Liberia serving as the head of case detection for the National Ebola Response team and administering critical aspects of Liberia’s Ebola response.</p>
<p>The outbreak affected Sierra Leone, Guinea and Liberia. It <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002508#:%7E:text=The%202014%E2%80%932015%20Ebola%20virus%20disease%20(EVD)%20outbreak%20across,in%204%2C809%20deaths%20%5B1%5D.">claimed 11,310</a> lives and took <a href="https://www.sciencedirect.com/science/article/pii/S1876034120304275">36 months</a> to contain. It made its way along major highways from Guinea into Liberia and Sierra Leone, which share a long border.</p>
<p>Uganda’s current <a href="https://www.theeastafrican.co.ke/tea/business/uganda-ebola-death-toll-3963084">Ebola virus outbreak</a> has a few similarities. The first case was found in Mubende district, located on a major highway to the capital city, Kampala, and neighbouring Democratic Republic of Congo – putting both at high risk.</p>
<p>Ebola <a href="https://www.cdc.gov/vhf/ebola/symptoms/index.html">spreads through</a> body fluids and direct contact. The infectiousness of the virus increases as patients get sicker – when they vomit and have diarrhoea. At death the virus is at its most virulent and thus any communal burial increases the spread.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1572906430218506242"}"></div></p>
<p>In the 2014/2015 outbreak there was widespread disbelief in communities, due to ignorance, distrust and some traditional beliefs. People didn’t cooperate with response teams. Fear and disbelief <a href="https://www.monitor.co.ug/uganda/news/national/gaps-in-ebola-response-stick-out-as-cases-grow-3960154">have also been</a> documented in Uganda as four contacts of the alert case ran away from response workers.</p>
<p>If people doubt they have Ebola – because symptoms of fever or vomiting are similar to other common illnesses like malaria and typhoid – they’ll seek healthcare from a range of places, including traditional healers and religious groups. And they could move to urban centres in search of better care. All of these behaviours increase the risk of a further spread of the virus and more deaths.</p>
<p>On the positive side, Uganda has the <a href="https://www.afro.who.int/news/how-previous-ebola-virus-disease-outbreaks-helped-uganda-respond-covid-19-outbreak">right basics</a> to mount an effective response: experienced medical staff, knowledge and good infrastructure. The country has responded to four previous Ebola outbreaks. Its health systems are also in better shape than they were in three of the West African countries during the 2014/2015 outbreak. Health systems are as effective as the response and support they can get from the community.</p>
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Read more:
<a href="https://theconversation.com/ebola-outbreak-in-uganda-the-health-system-has-never-been-better-prepared-191021">Ebola outbreak in Uganda: the health system has never been better prepared</a>
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</p>
<hr>
<p>But the ability of Ebola to spread must not be underestimated. There’s a <a href="https://www.monitor.co.ug/uganda/news/national/gaps-in-ebola-response-stick-out-as-cases-grow-3960154">knowledge gap</a> about the actual start of the outbreak and the index (or first identified) case. This means the actual first human case of this current outbreak, coupled with <a href="https://www.monitor.co.ug/uganda/news/national/gaps-in-ebola-response-stick-out-as-cases-grow-3960154">increasing</a> community <a href="https://www.monitor.co.ug/uganda/news/national/five-ugandan-doctors-catch-ebola-3966020">infections</a> and deaths, raises the risk of the outbreak spreading along the major highway to densely populated cities and neighbouring countries.</p>
<p>There’s no approved vaccine for this strain of Ebola – the <a href="https://reliefweb.int/report/uganda/ebola-disease-caused-sudan-virus">Sudan strain</a>. This is due to the focus on Ebola Zaire, the most deadly and infectious strain, which was responsible for the 2014/2015 Ebola outbreak in West Africa.</p>
<p>It’s therefore crucial that the region be prepared to work together to contain the spread of the virus. Drawing on my experience in the management of the 2014/2015 outbreak in West Africa, here are the five steps that might help East Africa curb the further spread of the virus.</p>
<h2>1. Set up a robust cross-border surveillance system</h2>
<p>To prevent a further spread, a cross-border surveillance system must be created that can quickly identify, test and isolate cases for treatment. This system must have direct, simple communication lines with minimal bureaucracy. For instance, teams should use mobile applications like WhatsApp.</p>
<p>One of the biggest weaknesses we faced during the 2014/2015 Ebola outbreak was that response workers in Liberia, Sierra Leone and Guinea weren’t able to communicate easily with colleagues in other countries. This resulted in the use of intermediaries, like the World Health Organization (WHO) office, which caused delays. We lost the critical element of speed – every hour counts.</p>
<p>Communities along the borders must be part of the surveillance system. Ebola response workers in West Africa created a network along the borders that helped them move with speed. Cross border preparedness meetings and direct communication on the progress of the evolving outbreak in Uganda will be crucial for containment strategies.</p>
<h2>2. Create an army of community contact tracers</h2>
<p>To curb the Ebola outbreak in East Africa a portion of the response funding must be used to create an army of case finders and contact tracers. They must know people within their community well and report cases that families may be trying to hide. Fears, ignorance and cultural beliefs and practices tend to make contacts reluctant to report themselves; or they escape from treatment centres.</p>
<p>A crucial factor in containing the outbreak in Liberia was the payments of monthly stipends from the United Nations Development Fund and WHO to local pastors, imams, community leaders, teachers, university students and high school students. These ranged from US$80 to US$350 a month.</p>
<p>This is key because it can turn communities from being hostile to becoming champions of the effort. It also helps to create trust.</p>
<p>At the height of the Ebola outbreak in Liberia’s Montserrado County – where the capital is situated – we had 5,700 community leaders working with the response teams. They were able to visit 1.6 million households and identify thousands of sick people who were then either classified as suspect or probable cases by the more trained contact tracers.</p>
<p>These volunteers defeated Ebola because communities trusted them. Flying in foreigners at great cost <a href="https://reliefweb.int/report/democratic-republic-congo/security-challenge-community-distrust-and-resistance">has been less effective</a> because communities don’t have the same level of trust in them.</p>
<h2>3. Recruit trusted messengers</h2>
<p>Misinformation, disinformation and rumours make response efforts difficult. It can create great hostility to response teams. The recruitment of messengers trusted by communities, and armed with the right message, is key.</p>
<p>During the 2014/2015 oubreak, we targeted influential people within a community. They included a former fighter during the Liberian civil war - people respected him because he was a part of group that protected them from armed robbers.</p>
<h2>4. Rapid field testing should be used</h2>
<p>Fast testing and short turnaround times are crucial to isolating cases and preventing further spread.</p>
<p>In the West Africa outbreak, our teams would ask a family to isolate a suspected case in a different room. They would then draw blood and send the sample to the field lab. Within three hours we had the results. If the person was positive we moved them to the isolation centre. If negative, we asked them to self-isolate for 48 hours so we could test them again. This allowed the families to call us as soon as they suspected that one of them had fever.</p>
<p>We also did oral swabs of all dead bodies in the communities. This helped us to pick up cases of silent super spreaders who had spread the virus <a href="https://www.newsweek.com/2015/04/10/how-bloody-brawl-sparked-fears-new-ebola-outbreak-liberia-318442.html">but were misdiagnosed</a> in the community.</p>
<p>Both of these approaches helped us to restore confidence with the community and gave us much speed.</p>
<h2>5. Increase surveillance of all vehicles</h2>
<p>Since this outbreak is occurring at a major road leading to Kampala and DRC, the surveillance of all vehicles is critical.</p>
<p>In Liberia, we recruited and trained motorbike riders and transport vehicle riders. We gave them ledgers and notebooks and embedded them with our surveillance teams. They tracked all sick people and even took records of drivers who missed work. These were visited at home to see if they were sick.</p>
<p>Tracing – documenting the full address and host – was done on all recent passengers. This helped us to tightly monitor the movements of people from the epicentre.</p><img src="https://counter.theconversation.com/content/191506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mosoka Fallah works as the Program Manager for Saving Lives and Livelihoods at the Africa Center for Disease Control</span></em></p>When tackling an Ebola outbreak speed is a critical element - every hour counts.Mosoka Fallah, Part-time lecturer at the Global Health & Social Medicine, Harvard University, and Lecturer at the School of Public Health, College of Health Sciences, University of LiberiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1910212022-09-24T09:31:31Z2022-09-24T09:31:31ZEbola outbreak in Uganda: the health system has never been better prepared<figure><img src="https://images.theconversation.com/files/485855/original/file-20220921-26-p2vwyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical staff prepare to enter a hospital isolation unit in western Uganda during a suspected Ebola outbreak in 2018.
</span> <span class="attribution"><span class="source">Sumy Sadurni/AFP via Getty Images</span></span></figcaption></figure><iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/ebola-outbreak-in-uganda-the-health-system-has-never-been-better-prepared-191021&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>An outbreak of the deadly Ebola virus was <a href="https://twitter.com/MinofHealthUG/status/1572104820735242241">announced</a> by Uganda’s ministry of health on 21 September 2022. Uganda has had at least six <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease?gclid=Cj0KCQjwj7CZBhDHARIsAPPWv3ennosVtaUFIYNWFdyia94wYtYp3Zgl7TjYG4-yccNy5P3xg3Hu2-0aAljpEALw_wcB">previous episodes of Ebola</a> in 2000 (224 dead), 2007 (37 dead), 2011 (1 dead), two events in 2012 (21 dead) and 2019 (4 dead). The recently confirmed case is of the less deadly <a href="https://news.un.org/en/story/2022/09/1127181">Sudan strain</a>. Abdhalah Ziraba, a public health researcher who heads the emerging and re-emerging infectious diseases research unit at <a href="https://aphrc.org/?gclid=Cj0KCQjw7KqZBhCBARIsAI-fTKLIQ5oo5NysMkYwJPvVr-sV4FhjKHQAThy_SmhcnesmGn3NbUFDnJcaAqUnEALw_wcB">African Population and Health Research Center</a>, outlines Uganda’s preparedness this time around.</em></p>
<h2>What is known about the latest outbreak of Ebola in Uganda?</h2>
<p>The first confirmed case is a 24-year-old man who presented on the 11th of September 2022 with symptoms of Ebola. The case was confirmed on 19 September 2022 through laboratory testing. Laboratory results showed that he died from the Sudan strain of Ebola, which was last identified in the country in 2012. The Sudan ebolavirus generally has a lower case fatality rate than the Zaire strain, which broke out in DRC and parts of Uganda in <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010205">2018</a>.</p>
<p>Other <a href="https://news.un.org/en/story/2022/09/1127181">suspicious deaths</a> in the month of September 2022 and patients in the same district are being investigated to establish whether they succumbed to Ebola. As of the 23rd September 2022, there were 11 confirmed cases. </p>
<h2>What are the risks to public health?</h2>
<p>The Ebola virus is <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease?gclid=Cj0KCQjwj7CZBhDHARIsAPPWv3ennosVtaUFIYNWFdyia94wYtYp3Zgl7TjYG4-yccNy5P3xg3Hu2-0aAljpEALw_wcB">highly infectious</a> and mainly transmitted through contact with body fluid of infected persons.</p>
<p>The risk to the public is real as the first documented case could have exposed family members and also members of the public in close contact. The next few days are critical to identify any secondary cases and their potential contacts.</p>
<p>Ebola tends to have a high case fatality rate – out of those infected a high proportion end up dying. In the 2000 outbreak in <a href="https://doi.org/10.1046/j.1365-3156.2002.00944.x">northern Uganda</a>, more than half (53%) of all those infected with the virus succumbed to it. Depending on the strain of the virus and public health response in place, the fatality rate can <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">range</a> anywhere between 25% and 90% of those infected. The 2000 <a href="https://pubmed.ncbi.nlm.nih.gov/12460399/">outbreak</a> resulted in 224 deaths out of 425 cases that were reported countrywide.</p>
<h2>What response measures has Uganda put in place over the years?</h2>
<p>Uganda borders on regions of the Democratic Republic of Congo that have suffered <a href="https://www.msf.org/drc-ebola-outbreaks">numerous outbreaks</a> of Ebola. The last of these was <a href="https://news.un.org/en/story/2022/08/1125212">reported</a> in August 2022. Uganda itself has experienced several past outbreaks. For these reasons the country has developed a functional <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894352/">surveillance system</a> to flag and confirm suspicious cases early.</p>
<p>Uganda’s viral haemorrhagic fever surveillance programme was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894352/#:%7E:text=Uganda's%20national%20viral%20haemorrhagic%20fever,s%20Viral%20Special%20Pathogens%20Branch.">established</a> in 2010 in collaboration with the viral special pathogens branch of the US Centers for Disease Control and Prevention (CDC). The surveillance programme has a diagnostic laboratory, staff, supplies and sentinel surveillance centres for the rapid detection of outbreaks. In the current outbreak, the turnaround time (24-48 hours) for laboratory testing was short and done at a laboratory located within the country.</p>
<p>Delayed action, poor health education messaging and slow behaviour change helped spur the outbreaks in West Africa in 2014-2016 and eastern DRC in 2019. Uganda has drawn lessons from these and its own large outbreak in 2000 and it is not taking chances.</p>
<h2>What useful lessons can Uganda offer based on previous experience?</h2>
<p>Public health messaging is critical and has worked well for Uganda in past outbreaks. Health education campaigns carry messages on prevention practices, manifestation of symptoms and what to do in case of contact or infection.</p>
<p>Another critical factor is having <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00548-5">rapid</a> response teams on standby. Uganda has developed this capability.</p>
<p>Just as important is the need for a strong surveillance system to pick up suspicious cases early. Front-line health care workers have been trained to be able to pick out suspected cases, which in turn get isolated. Suspected cases are given supportive treatment, reported and specimens collected and sent to the reference lab for analysis. Once a case is confirmed efforts are made to manage cases and prevent further transmission. The ministry of health and partners also provide the capacity to evaluate and care for a markedly increased volume of patients. </p>
<p>Uganda has local laboratory capacity at the Uganda Virus Research Institute at Entebbe. The laboratory has the capacity to test and confirm whether suspect cases are indeed Ebola virus disease cases. Timely confirmation is important to trigger the rapid response required. This includes contact tracing, health education and care for those who are infected.</p>
<p>Uganda has also learnt the value of sounding the international alarm at the earliest. It did so this time round, alerting the WHO within hours of detecting the first suspected case.</p>
<h2>What challenges remain?</h2>
<p>Tracing of contact cases can be challenging due to population mobility. For example, an infected person might travel to a populated urban centre using public transport and possibly get attended to in a health facility by unsuspecting health workers. Along the way many contacts will be made which are difficult to trace should the suspect case be confirmed.</p>
<p>On top of this, rigorous contact tracing and treatment of confirmed cases costs money. So technical support and resources need to be made available. </p>
<p>Looking to the future, the EVD problem needs to be addressed from all angles. <a href="https://www.cdc.gov/vhf/ebola/transmission/index.html#:%7E:text=Scientists%20think%20people%20are%20initially,a%20large%20number%20of%20people.">Human-wildlife</a> contacts, including eating wild meat, is a risk for transmission. It is suspected that bats and primates are the animal sources of the virus and therefore they are better avoided, especially in endemic areas. </p>
<p>Lastly, the available vaccine may not be effective against the strain that has broken out in Uganda. Currently, the only approved vaccine is one for the Zaire strain. The vaccine for the Sudan strain has not yet been approved.</p>
<p>This Ebola virus disease outbreak and others before it as well as the COVID-19 pandemic are a reminder that infectious diseases – new or old – pose a major threat to public health that requires investment and action to safeguard human health.</p><img src="https://counter.theconversation.com/content/191021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abdhalah Ziraba does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Sudan strain of the Ebola virus has been identified in Uganda for the first time in more than a decade.Abdhalah Ziraba, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902562022-09-23T03:03:59Z2022-09-23T03:03:59ZAfrican newspapers can be anti-African too: what my research found<figure><img src="https://images.theconversation.com/files/485562/original/file-20220920-19-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ebola news was the top story in Nigeria in early August 2014.</span> <span class="attribution"><span class="source">Photo by Mohammed Elshamy/Anadolu Agency/Getty Images</span></span></figcaption></figure><p>Following the recent outbreak of <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html">monkeypox in Europe and North America</a> the international news media were accused of <a href="https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/may/20220522_PR_Monkeypox">bias in their reporting</a>. The accusation is that media outlets perpetuated negative stereotypes by, for example, portraying monkeypox as a disease that affects only African people, or people of African descent. </p>
<p>The accusations stem from editorial decisions to use stock images of Africans, people of African descent, or people living in Africa, when reporting an outbreak that predominantly affected countries in the global north. </p>
<p>The Foreign Press Association, Africa <a href="https://twitter.com/fpa_africa/status/1527990596044001282">said</a> these types of reports showed a “glaring lack of dignity afforded to black and brown-skinned victims of disease outbreaks.” </p>
<p>Numerous pieces of research have shown that western media <a href="https://www.jstor.org/stable/490566">misrepresent Africa</a> when reporting on diseases, and portray the west as superior and Africa as inferior. </p>
<p>My findings, in a <a href="https://link.springer.com/chapter/10.1007/978-3-030-95100-9_10#DOI">recently published paper</a>, show that African publications can be just as guilty of this. I looked at media coverage of the 2014 Ebola outbreak as well as the COVID-19 2020 pandemic in two newspapers – the South African daily, the <a href="https://www.sowetanlive.co.za/">Sowetan</a> and the Nigerian daily broadsheet, the <a href="https://dailytrust.com/">Daily Trust</a>. Both papers reported on both outbreaks.</p>
<p>I also reviewed literature that looked at news reports on diseases such as HIV and AIDS as well as cancer.</p>
<p>My research showed that the reporting misrepresented Africa, and portrayed Africans as inferior and dangerous. In doing this, they perpetuated an ideology of othering that emphasises the west as superior and Africa as inferior.</p>
<h2>The analysis</h2>
<p>I looked at the language used in these newspapers, as well as the volume of coverage by subject matter and by country. I considered close to 200 news reports on the 2014 Ebola outbreak and the 2020 coronavirus outbreak published by the Daily Trust and the Sowetan. They are among the most widely read and distributed in <a href="https://content.app-sources.com/s/49873730264296551/uploads/Novus_Group_Documents_/South_African_Print_Media_Landscape_Report_-_July_2021-9316612.pdf">their respective countries</a>. </p>
<p>I chose to focus on two 31-day periods: 1 August 2014 to 31 August 2014 for Ebola and 23 March 2020 to 23 April 2020 for the COVID-19 pandemic. These periods were chosen because they marked significant developments in the Ebola and coronavirus outbreaks. My focus was on how language and images were used.</p>
<p>I quantified the coverage: first in terms of continents and then on a country-by-country basis. </p>
<p>Figure 1 shows the number of news reports on the 2014 Ebola and 2020 coronavirus outbreaks at continental level. Figure 2 breaks this down further and shows which countries received the most coverage in the publications and period considered. </p>
<iframe title="News reports by continent" aria-label="Stacked Bars" id="datawrapper-chart-JPLHj" src="https://datawrapper.dwcdn.net/JPLHj/1/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="292" width="100%"></iframe>
<p>When it came to the 2020 coronavirus outbreak, three of the four most reported on countries were western countries – America, Italy and England. All had very high rates of infection and death. The fourth most mentioned country was China, where the outbreak originated. </p>
<iframe title="News reports by country" aria-label="Grouped Bars" id="datawrapper-chart-Y8O2H" src="https://datawrapper.dwcdn.net/Y8O2H/3/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="525" width="100%"></iframe>
<p>While this could have been expected, the contrast with Africa is marked because individual countries weren’t mentioned even though the continent overall received a great deal of coverage. The conclusion is that for these publications, developments in individual African countries were not prioritised to the same degree as developments in individual western states.</p>
<p>Next I analysed the headlines and the body of the articles to understand how words were used. The framework I used, <a href="https://sk.sagepub.com/books/ideology">known as the ideological square</a>, is rooted in a view of language-use as something that advances ideology, particularly in how it includes and esteems through references to “us” and excludes or disparages through reference to “them”. </p>
<p>This “us vs them” perspective is commonly known as <a href="https://discourses.org/wp-content/uploads/2022/06/Teun-A.-van-Dijk-1991-Racism-And-the-Press.pdf">othering or otherness</a>. </p>
<p>Language that alludes to “us” is associated with favourable properties, while language that alludes to “them” is associated with negative properties.</p>
<p>I found examples of this in news reports on specific individuals who were infected or died due to either of these two viruses. The tendency was to emphasise the humanity and positive traits of affected western individuals while either anonymising or writing negatively about African individuals. This was particularly evident in news reports on Ebola.</p>
<p>Take the reporting on the first European Ebola victim <a href="https://www.pressreader.com/nigeria/daily-trust/20140808/281702612862873">as reported</a> in The Daily Trust.</p>
<blockquote>
<p>The first European infected by a strain of Ebola that has killed more than 932 people in West Africa, Spanish priest Miguel Pajares, was stable in Madrid.</p>
</blockquote>
<p>The infected person is named, and the report goes as far as to tell us he is a priest, a role that carries positive connotations. </p>
<p>But reporting on the first Ebola victim in Nigeria used words like <a href="https://www.pressreader.com/nigeria/daily-trust/20140813/281483569537959/textview">“importer” and “suspect”</a>.</p>
<p>My research showed other differences too. For example, when it came to the coronavirus, the <a href="https://www.news24.com/news24/analysis/fact-check-africa-didnt-fare-better-during-covid-than-rest-of-the-world-20220906">fact</a> that African countries kept deaths and infections to a minimum was de-emphasised. Instead, the emphasis was on the donations western countries were making to African countries.</p>
<p>When it came to the economic impact of the coronavirus outbreak, the reports emphasised <a href="https://www.pressreader.com/nigeria/daily-trust/20200324/page/8">pessimistic forecasts</a> on how African countries would be affected.</p>
<p>Finally, when it came to domestic developments in different countries, the emphasis was on what was going right in western countries and what was going wrong in African countries. An example was that there were no news reports on the public outcry against government lockdown in western nations. But <a href="https://www.bbc.com/news/world-africa-52268320">there</a> were <a href="https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-africa/">several about African countries</a>.</p>
<h2>Insights</h2>
<p>The outbreak of a disease, whether local or global, is not merely a public health matter. It is also a health communication issue, as people need information to help them respond. Established information sources, such as newspapers, become critical in shaping how the public understands and responds to the crisis.</p>
<p>But media sources play another role too – they frame how issues are seen. My research confirmed that the coverage perpetuated the “us versus them” ideology. The articles reflected negative self-representation of the African continent and positive other-representation of western countries in the same way as western newspapers often do.</p><img src="https://counter.theconversation.com/content/190256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sisanda Nkoala is a past grant recipient of funding from the National Research Foundation</span></em></p>African media also emphasise the west as superior and Africa as inferior.Sisanda Nkoala, Senior Lecturer, Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1875422022-07-23T09:34:39Z2022-07-23T09:34:39ZThe Marburg virus: urgent need to contain this close cousin of Ebola<figure><img src="https://images.theconversation.com/files/475615/original/file-20220722-18-62rym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Roger Harris/Science Photo Library</span></span></figcaption></figure><p><em>The Marburg virus is a highly infectious disease that’s in the same family as the virus that causes Ebola. The Conversation Africa’s Wale Fatade and Usifo Omozokpea asked virologist Oyewale Tomori about its origin and how people can protect themselves against the disease.</em></p>
<h2>What is the Marburg virus and where did it come from?</h2>
<p>Marburg virus causes the Marburg Virus Disease (MVD), formerly known as Marburg haemorrhagic fever. The virus, which belongs to the same family as the Ebola virus, causes severe viral haemorrhagic fever in humans with an average case fatality rate of <a href="https://www.cdc.gov/vhf/marburg/index.html">around</a> 50%. It has varied <a href="https://www.cdc.gov/vhf/marburg/index.html">between</a> 24% to 88% in different outbreaks depending on virus strain and case management. </p>
<p>It was <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">first reported</a> in 1967 in a town called Marburg in Germany and in Belgrade, Yugoslavia (now Serbia). There were simultaneous outbreaks in both cities. It came from monkeys imported from Uganda for laboratory studies in Marburg. The laboratory staff got infected as a result of working with materials (blood, tissues and cells) of the monkeys. Of 31 cases associated with these outbreaks, seven people died.</p>
<p>After the initial outbreaks, other cases have been reported in different parts of the world. <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">Most were in Africa</a> – Uganda, the Democratic Republic of Congo, Kenya, South Africa, and more recently in Guinea and Ghana. Serological <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968259/">studies</a> have also revealed evidence of past Marburg virus infection in Nigeria. </p>
<p>While the host, or reservoir, of the virus is not conclusively identified, the virus has been <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">associated with fruit bats</a>. <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">In 2008</a>, two independent cases were reported in travellers who had visited a cave inhabited by Rousettus bat colonies in Uganda.</p>
<h2>How is it spread?</h2>
<p>It is spread through contact with materials (fluids, blood, tissues and cells) of an infected host or reservoir. In the case of the monkeys from Uganda imported into Marburg, laboratory staff obviously got infected through contact with the tissues and the blood of the monkeys. </p>
<p>There can also be human-to-human transmission via <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">direct contact</a> (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials. This includes materials like bedding, and clothing contaminated with these fluids.</p>
<p>But there’s a great deal we don’t know. For example, whether contact with bat droppings in caves can cause infections in people. </p>
<h2>What are the symptoms? And how bad can they be?</h2>
<p>After an incubation period of between 2 to 21 days, there is a sudden onset of the disease marked by fever, chills, headache, and myalgia. </p>
<p>Around the fifth day after the onset of symptoms, maculopapular rash, most prominent on the trunk (chest, back, stomach), <a href="https://www.cdc.gov/vhf/marburg/symptoms/index.html">may appear</a>. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.</p>
<p>The <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">mortality is around 50%</a>, and could be as high as 88% or as low as 20%. </p>
<h2>Can it be treated?</h2>
<p>Not really, but <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">early supportive care</a> with rehydration, and symptomatic treatment, improves survival. </p>
<h2>What can people do to protect themselves?</h2>
<p>Avoid exposure to the virus as much as possible, and protect against discharges from infected people. </p>
<p>Also, because of the similarities in the symptoms of many hemorrhagic fever diseases, especially during the early stages, there is a need for reliable laboratory confirmation of a case of Marburg virus infection. And once that is done – as with Ebola – the person must immediately be isolated and avoid contact with other people. </p>
<h2>What should be done to ensure the virus doesn’t spread?</h2>
<p>There is no holiday from disease outbreaks. That means as a country, surveillance cannot take a break or a holiday.</p>
<p>When cases are reported, it’s time to be on the alert. Proper screening is called for. Arrivals from the affected country and other neighbouring countries must be checked at the ports of entry. </p>
<p>Studies <a href="https://www.ajtmh.org/view/journals/tpmd/38/2/article-p407.xml">done in Nigeria in the the 1980s</a> and more recently in the 1990s provide evidence of possible previous infections with Marburg virus – or a related virus – in certain Nigerian populations. This leads me to believe that the virus is probably more widespread than we think it is. We need an improvement in diagnosis which can help us do the detection as quickly, and as efficiently as possible.</p>
<p>On top of this, countries need to improve their disease surveillance and laboratory diagnosis to enhance and improve the capacity for a more definitive diagnosis of viral hemorrhagic fever infections.</p><img src="https://counter.theconversation.com/content/187542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oyewale Tomori does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The chances of surviving Marburg are improved if there’s early supportive care with rehydration and symptomatic treatment.Oyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777212022-03-15T12:15:32Z2022-03-15T12:15:32ZThe Ebola virus can ‘hide out’ in the brain after treatment and cause recurrent infections<figure><img src="https://images.theconversation.com/files/452000/original/file-20220314-13-5nsas.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1536&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This image shows Ebola virus particles (red) budding from the surface of kidney cell (blue).</span> <span class="attribution"><a class="source" href="https://flic.kr/p/oq68Cn">National Institute of Allergy and Infectious Diseases/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>The Ebola virus can hide in the brains of monkeys that have recovered after medical treatment without causing symptoms and lead to recurrent infections, according to a study by a <a href="https://www.researchgate.net/profile/Xiankun-Zeng">team I led</a> that was published in the journal <a href="https://doi.org/10.1126/scitranslmed.abi5229">Science Translational Medicine</a>.</p>
<p><a href="https://www.cdc.gov/vhf/ebola/index.html">Ebola is one of the deadliest</a> infectious disease threats known to humankind, with an <a href="https://www.afro.who.int/health-topics/ebola-virus-disease">average fatality rate of about 50%</a>. Ebola is known for a high level of <a href="https://doi.org/10.1038/nmicrobiol.2017.124">viral persistence</a>, meaning the virus remains lurking in the body even after a patient has recovered. But where this hiding place is remains largely unknown.</p>
<p>In 2021, there were <a href="https://www.cdc.gov/vhf/ebola/outbreaks/index-2018.html">three Ebola outbreaks in Africa</a>, all linked to previously infected survivors. Ebola also reemerged in <a href="https://doi.org/10.1038/s41586-021-03901-9">Guinea</a> that same year, linked to a survivor of the 2013-2016 Ebola outbreak.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A laboratory technician in full Personal protective equipment pipettes samples under a lab hood." src="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452004/original/file-20220314-131639-4tbiwk.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The researchers conducted their study in a Biosafety Level 4 lab, the highest level of biocontainment required to safely study hazardous pathogens like Ebola.</span>
<span class="attribution"><span class="source">John W. Braun, USAMRIID</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>We wanted to better understand where the Ebola virus “hides” in the body of survivors and what triggers recurrent infections. So we examined 36 rhesus monkeys that had been treated for Ebola with <a href="https://www.uptodate.com/contents/overview-of-therapeutic-monoclonal-antibodies">monoclonal antibody therapy</a>, a type of treatment that helps the immune system mount an attack against an infection. These monkeys were deemed fully recovered with no symptoms of infection or detectable virus in their blood. </p>
<p>When we looked more closely at the tissues of different organs under a microscope, however, we found that about 20% of recovered monkeys still had visible Ebola virus located exclusively in the <a href="https://www.ncbi.nlm.nih.gov/books/NBK11083/">ventricular system</a> of the brain. This brain region produces, circulates and stores <a href="https://medlineplus.gov/lab-tests/cerebrospinal-fluid-csf-analysis/">cerebrospinal fluid</a>, which protects, supplies nutrients to and removes waste products from the brain.</p>
<p>Importantly, despite being asymptomatic at the start of our study, two of the monkeys we observed developed Ebola symptoms before dying at 30 and 39 days after their initial infection, respectively. Our findings suggest that the Ebola virus can hide dormant in the brains of survivors even after treatment, and the virus can reactivate and cause fatal infections later on.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Ventricular system of rhesus monkey that survived Ebola virus infection, with brown stains indicating viral persistence lining the edges" src="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=301&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=301&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=301&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452005/original/file-20220314-101106-3uxlee.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This image shows the brain ventricular system of a rhesus monkey that survived Ebola virus infection, where brown indicates viral persistence.</span>
<span class="attribution"><span class="source">Kevin Zeng</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>Treatment with monoclonal antibodies is the current <a href="https://www.statnews.com/2020/10/15/thank-this-ebola-fighting-african-doctor-muyembe-tamfum-for-monoclonal-antibody-treatments/">standard of care for Ebola</a>. But recurrent infections can occur even after apparently successful treatment, and patients can inadvertently transmit the virus and cause new outbreaks.</p>
<p>Our study underscores the importance of careful long-term medical follow-up of successfully treated Ebola survivors to counter the individual and public health cost of recurrent disease. This follow-up, however, will need to be conducted in a way that does not further <a href="https://longreads.trust.org/item/Ebola-survivors-DRC-combat-stigma-misinformation">stigmatize survivors of the disease</a>.</p>
<h2>What still isn’t known</h2>
<p>We still don’t know why the Ebola virus persists in the brain and causes recurrent infections. It is also unclear whether this persistence might be related to monoclonal antibody treatments, and whether other types of therapies, such as antivirals, might produce a different effect. Researchers are still looking into what triggers relapses and whether there might be other parts of the body that may act as reservoirs.</p>
<h2>What’s next</h2>
<p>Our work highlights the need to more deeply investigate why the Ebola virus persists in the brain. Because the brain is <a href="https://doi.org/10.4161/mabs.3.2.14239">less accessible</a> to monoclonal antibodies, treatments <a href="https://doi.org/10.1016/S1473-3099(20)30282-6">combining both monoclonal antibodies and antiviral drugs</a> may help prevent and clear persistent Ebola infection and related disease in the brain. Analyzing viral persistence at the <a href="https://doi.org/10.1038/s41579-020-0354-7">molecular level</a> may provide more insight.</p>
<p>[<em>Research into coronavirus and other news from science</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-corona-research">Subscribe to The Conversation’s new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/177721/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Zeng does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although treatments for Ebola have helped many people overcome this deadly disease, the virus can persist in the brain and cause a lethal relapse.Kevin Zeng, Principal Investigator of Infectious Diseases, U.S. Army Medical Research Institute of Infectious DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777462022-03-02T18:40:59Z2022-03-02T18:40:59ZFuture infectious diseases: Recent history shows we can never again be complacent about pathogens<figure><img src="https://images.theconversation.com/files/449127/original/file-20220301-23-k3vb1g.jpg?ixlib=rb-1.1.0&rect=536%2C0%2C2189%2C1331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 will not be the last infectious disease event of our time. We need to prepare for the next challenge with evidence and knowledge.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As we move into the third year of the global pandemic caused by COVID-19, it’s important to ask what we have learned and what we have done to prepare for the next infectious-disease crisis.</p>
<p>It could be an outbreak of Lyme disease, an epidemic of measles or another full-blown global pandemic of influenza or coronavirus. It could be a threat that emerges from the ongoing challenge of <a href="https://www.cdc.gov/drugresistance/about.html#:%7E:text=Antibiotic%20resistance%20happens%20when%20germs,in%20the%20U.S.%20each%20year.">antimicrobial resistance</a> and the steadily fading power of established antibiotics.</p>
<p>One thing is certain: COVID-19 will not be the last challenge of our time, and even while we are striving to tame the current pandemic, we need to prepare for the next challenge, using evidence and knowledge.</p>
<h2>Infectious diseases</h2>
<p>For most of human history, <a href="https://doi.org/10.1001/jama.281.1.61">infectious diseases have been the leading cause of death</a>, preying mainly on the very young, the old and the most vulnerable among us.</p>
<p>Scientific advancements in the 20th century reversed this historical trend — at least for a time.</p>
<p>Our ability to control infection through <a href="https://doi.org/10.1146/annurev.publhealth.20.1.0">public health measures</a> such as clean water and by developing vaccines, antibiotics, antiviral and antiparasitic agents has changed the way we live — and the way we die.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Old illustration of a large room with a row of patients in beds and nurses looking after them" src="https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=489&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=489&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=489&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=614&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=614&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448861/original/file-20220228-25-127fpd2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=614&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For most of human history, infectious diseases have been the leading cause of death.</span>
<span class="attribution"><span class="source">Hampstead Smallpox Hospital, London. Wellcome Collection.</span></span>
</figcaption>
</figure>
<p>Statistics Canada data show that controlling infectious diseases has bought us more than <a href="https://www150.statcan.gc.ca/n1/pub/11-630-x/11-630-x2016002-eng.htm">two decades of extra life</a>, on average. It’s a remarkable achievement, and as a result, diseases of aging — <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/201126/t001b-eng.htm">cancer, cardiovascular illness, chronic ailments, and degenerative neurological diseases such as Alzheimer’s</a> — are now the major causes of death. </p>
<p>What we should have learned over the last few decades, however, is that our control over infection is illusory and that we remain vulnerable. </p>
<p>The 1970s saw the emergence of <a href="https://www.cdc.gov/flu/swineflu/keyfacts_pigs.htm">swine flu</a> and <a href="https://www.cdc.gov/legionella/about/history.html#:%7E:text=Legionella%20was%20discovered%20after%20an,became%20known%20as%20Legionnaires'%20disease.">Legionnaire’s disease</a>. The ‘80s brought <a href="https://www.who.int/news-room/fact-sheets/detail/hiv-aids">HIV/AIDS</a>, the '90s witnessed <a href="https://www.who.int/health-topics/ebola/#tab=tab_1">Ebola</a> and the early 2000s brought the return of <a href="https://www.who.int/emergencies/situations/influenza-a-(h1n1)-outbreak">influenza with H1N1</a>, the <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1">first SARS crisis</a> and <a href="https://www.who.int/health-topics/middle-east-respiratory-syndrome-coronavirus-mers#tab=tab_1">Middle East respiratory syndrome (MERS)</a>. </p>
<p>During that same period, the pharmaceutical industry <a href="https://doi.org/10.1038/d41586-020-02884-3">put antibiotic discovery on the back burner</a>, favouring the invention of more profitable treatments for chronic diseases, with their endlessly renewable prescriptions.</p>
<p>Without alternatives to penicillin, <a href="https://doi.org/10.1016/S0140-6736(22)00087-3">antimicrobial resistance has become, like climate change, a slow-moving but inexorably advancing global crisis</a>.</p>
<h2>Infection control</h2>
<p>The current pandemic has forced governments, public health officials and the health-care sector overall into a prolonged emergency footing, showing us very clearly that we cannot take infection control for granted.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Brightly coloured illustrations of microbes that stop where six arms in white sleeves meet, with their gloved hands clasped to form a barrier" src="https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449129/original/file-20220301-13-15tqsbo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The COVID-19 pandemic has made it clear that infection control cannot be taken for granted.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>At the same time, we have been able to benefit from ongoing advancements in fundamental research and development. These advancements have enabled swift response to the current crisis with <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">multiple vaccine platforms</a>, <a href="https://dx.doi.org/10.1016%2FS1473-3099(21)00048-7">do-it-yourself diagnostic tests</a> featuring unprecedented sensitivity, <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-drugs-treatments.html">new antiviral drugs and antibodies</a>, and the real-time production of robust evidence and information to keep pace with every turn in the pandemic saga.</p>
<p>Information technology has developed with amazing speed, providing the opportunity to disseminate critical information instantly. The <a href="https://doi.org/10.1038/s41586-020-2008-3">complete genome sequence of SARS-CoV-2</a>, for example, was available to researchers across the globe well before the COVID-19 virus arrived on their doorsteps. </p>
<p>Still, this same technology has also <a href="https://toronto.ctvnews.ca/misinformation-on-social-media-linked-to-higher-spread-of-covid-19-in-new-study-1.5466846">provided a platform for those who would discredit these scientific advances</a>, oppose public health sector leaders, and even interfere with front-line workers caring for patients.</p>
<h2>One Health</h2>
<p>Infectious diseases are almost always what we call <a href="https://www.cdc.gov/onehealth/basics/index.html">One Health</a> problems. The term refers to the intimate link between human and animal health, agriculture and the environment. </p>
<p>Microbes that cause disease often move easily between reservoirs in the environment, animals and people. Human encroachment into previously remote regions continues at an alarming rate, <a href="https://doi.org/10.1186/s40101-020-00239-5">exposing us to previously isolated viruses, bacteria and parasites</a>.</p>
<p><a href="https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2019-45/issue-5-may-2-2019/article-5-observatory-climate-change-adaptation-quebec.html">Climate change is creating new vectors to spread these diseases</a>, such as ticks and mosquitoes migrating into newly warmed environments.</p>
<p>As climate change continues and the demand for nutrition grows, strains on the environment will generate new infection challenges. Seeing three unique, novel coronaviruses (SARS, MERS and SARS-CoV-2) jump from environmental reservoirs into humans in the space of a two decades should have spurred us to be vigilant, alert and prepared, yet we still aren’t ready enough. </p>
<h2>Complacency</h2>
<p><a href="https://www.cbc.ca/news/politics/auditor-general-pandemic-covid-phac-1.5963895">Public-health</a> <a href="https://doi.org/10.17269/s41997-020-00342-1">infrastructure</a>, research into <a href="https://www.universityaffairs.ca/news/news-article/massive-investments-needed-now-to-avoid-next-pandemic/">infectious diseases</a> and the development of new therapies have been neglected for decades.</p>
<p>Before the pandemic, our increased lifespans and ability to neutralize some infections with preventions and treatments had lulled us into complacency regarding the infectious diseases we had once rightly feared. </p>
<p>With such easily accessible global travel and a standard of living that relies on international trade, turning back the clock is impossible. </p>
<p>We must anticipate and <a href="https://www.youtube.com/watch?v=DQtoi-n_K9Y">prepare for more outbreaks</a>, <a href="https://www.statnews.com/2021/05/18/luck-is-not-a-strategy-the-world-needs-to-start-preparing-now-for-the-next-pandemic/">epidemics</a> and <a href="https://www.gavi.org/vaccineswork/next-pandemic">pandemics</a>. </p>
<p>We need to establish robust research networks and be able to mobilize them quickly <a href="https://www.ctvnews.ca/health/the-world-is-unprepared-for-the-next-pandemic-study-finds-1.5699732">when new problems emerge</a>.</p>
<p>We need to invest in <a href="https://theconversation.com/the-roots-of-canadas-covid-19-vaccine-shortage-go-back-decades-154792">biomedical and biomanufacturing infrastructure</a> that can respond urgently to these challenges enabling us to <a href="https://edmontonjournal.com/news/postpandemic/post-pandemic-how-has-covid-19-changed-the-way-canada-thinks-about-and-studies-vaccines">rapidly produce new vaccines and drugs</a>. </p>
<p>If we do not invest continuously in these platforms, we will doom ourselves to still more crises that we could have anticipated and prevented.</p><img src="https://counter.theconversation.com/content/177746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gerry Wright consults and owns shares in Prokaryotics, an antibiotic discovery company. </span></em></p>Before COVID-19, clean water, antibiotics and vaccines had made us complacent about infectious disease. Infection control can no longer be taken for granted. We must be prepared for future pandemics.Gerry Wright, Professor of Biochemistry and Biomedical Sciences, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1781702022-03-01T12:46:51Z2022-03-01T12:46:51ZLeçons tirées de la 10ème épidémie de la maladie à virus Ebola en RDC: la population serait mieux informée qu'on le pense<figure><img src="https://images.theconversation.com/files/449136/original/file-20220301-23-21lsme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">GettyImages</span> <span class="attribution"><span class="source">Alexis Huguet/AFP via Getty Images</span></span></figcaption></figure><p>Le 1er août 2018, la 10e épidémie de la Maladie à Virus Ebola (MVE) a été déclarée en République Démocratique du Congo (RDC) dans la Province du Nord-Kivu. La réponse internationale à l’épidémie a été énorme avec un afflux de plus <a href="https://www.liberation.fr/planete/2020/02/04/en-rdc-la-riposte-de-l-oms-rattrapee-par-l-ebola-business_1776970/">d’un demi-milliard de dollars</a> américains d’aide internationale. Un vaccin hautement protecteur nouvellement approuvé a été utilisé et de nouveaux médicaments comme agents thérapeutiques ont été testés et se sont avérés effiaces dans la réduction du taux de mortalité due à la MVE.</p>
<p>Pourtant, le 25 juin 2020, jour de déclaration officielle de la fin de la 10e l’épidémie de la MVE causant <a href="https://www.who.int/news/item/25-06-2020-10th-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-over-vigilance-against-flare-ups-and-support-for-survivors-must-continue">2,287 morts sur une période de 23 mois</a>, il s’est avéré qu’elle a été la plus virulente épidémie à affecter le Congo et la deuxième riposte la plus grande et la plus longue au monde jusqu’à ce jour.</p>
<p>Le vaste dispositif de santé publique mis en place pour lutter contre Ebola a généré des problèmes, y compris <a href="https://www.reuters.com/article/congo-ebola-sexcrimes-idUSL8N2L953V">des abus sexuels</a> et des conflits. Bien qu’officiellement, le nombre exact ne soit pas connu, il y a eu probablement <a href="https://cic.nyu.edu/sites/default/files/vir_ebola_report_02082021_en.pdf">quelque 200 à 300 épisodes de violence</a> directement liés à l’épidémie ou à l’égard des efforts nationaux et internationaux connus localement sous le nom de « Riposte ».</p>
<p>Nous avons voulu déterminer pourquoi la « Riposte » avait causé tant de frictions dans les communautés. Pour y arriver, nous avons étudié les différentes manières dont les communautés locales et la Riposte abordaient la prévention, le traitement et le suivi de cas d’Ebola.</p>
<p>Des analyses de l’action humanitaire requièrent une rigueur dans la recommandation des voies et moyens d'améliorer la gestion internationale des épidémies. Ainsi, dans notre série d’articles nous proposons une approche tout à fait différente. Nous alléguons que la gestion internationale des épidémies, consiste parfois à céder leur contrôle à un groupe d'experts étrangers qui possèdent, au mieux, une compréhension superficielle d’une région très complexe. Et nous suggérons que le savoir-faire local et les institutions congolaises pourraient avoir des capacités à mieux gérer une épidémie d’Ebola d’une manière efficace que les partenaires internationaux.</p>
<h2>Repenser la gestion des épidémies</h2>
<p>Notre recherche a été réalisée – de la conception à la publication – par un groupe des chercheurs congolais de différents horizons tant universitaire que professionnel. Nos quatre articles récemment publiés offrent des points de vue uniques à partir desquels on peut visualiser une épidémie par ailleurs fortement étudiée. Lorsqu’ils sont lus isolément, leurs conclusions peuvent sembler modestes : des analyses minutieuses des aspects importants de la 10e épidémie de la MVE. Cependant, pris dans leur ensemble, ils remettent en cause les fondements mêmes de la gestion internationale des épidémies.</p>
<p>Dans <a href="https://ethuin.files.wordpress.com/2021/10/swp6-muhindo-ebola-final.pdf">le premier de nos quatre articles</a>, nous nous concentrons sur Mangina, une cité du Nord-Kivu. Cette zone de santé a été le point de départ de la propagation de l'épidémie. Des cas d'Ebola avaient été documentés localement trois mois avant que l'épidémie ne soit officiellement déclarée et qu'une réponse internationale (la Riposte) ne soit déployée. A travers un suivi minutieux de la chaîne de transmission initiale, nous démontrons que les méthodes traditionnelles pour combattre la transmission des infections étaient remarquablement efficaces pour contrôler la propagation d’Ebola. Celles-ci comprenaient l'isolement des malades et l'utilisation de sacs en plastique pour enterrer les morts.</p>
<p>L'article montre comment les mécanismes de prévention et de soins développés localement ont ralenti la propagation de l'épidémie, qui a explosé de 26 cas dans les trois mois précédant le déploiement de la Riposte à 250 cas dans les trois mois suivants, quand les gens ont eu peur et ont commencé à se disperser davantage. Le cas de Mangina offre des leçons précieuses sur l'importance de promouvoir des stratégies de riposte aux épidémies qui soient inclusives, fiables et acceptées.</p>
<p>Dans <a href="https://ethuin.files.wordpress.com/2021/11/swp7-sivyavugha-final.pdf">le deuxième de nos quatre articles</a>, nous décrivons le dispositif de dépistage et de traitement de la MVE développé par la Riposte. Nous illustrons les effets pervers de l’approche militarisée de la Riposte, fondée sur la peur en matière de dépistage et de traitement. Cette approche a incité les patients à fuir la Riposte, ce qui a eu un impact négatif sur le taux de propagation, la morbidité et la mortalité de l'épidémie.</p>
<p>Nous arguons que si le personnel et les structures institutionnelles existants étaient utilisés pour gérer Ebola au lieu d’imposer de nouvelles structures, des décennies de confiance dans le système de santé congolais auraient pu être mises à profit pour impliquer la population dans les mesures de surveillance et de contrôle.</p>
<p>Dans <a href="https://ethuin.files.wordpress.com/2021/11/swp8-mukungilwa-final-1.pdf">le troisième de nos quatre articles</a>, nous considérons les défis auxquels les survivants sont confrontés. L'amélioration des traitements a considérablement réduit la mortalité lors de la 10e épidémie de la MVE en RDC. Pour ceux qui se sont présentés tôt dans l’évolution de leur maladie, Ebola n’était plus une condamnation à mort mais plutôt une maladie évitable et traitable. Ainsi, de nouvelles mesures ont été introduites pour les survivants. Ils recevaient des biens matériels à la sortie du centre de traitement ; ils étaient inscrits dans des groupes de soutien; et ils devaient suivre un processus de contrôle sanitaire très rigoureux.</p>
<p>Dans cet article, nous démontrons que les approches coercitives de la Riposte ont entrainé la peur des survivants et renforcé leur stigmatisation au sein de la communauté locale. Nous contestons également l'hypothèse selon laquelle les organisations humanitaires internationales devraient jouer un rôle de premier plan dans la réintégration des survivants au sein de la communauté.</p>
<p><a href="https://ethuin.files.wordpress.com/2021/10/swp5-muhindo-kwiravusa-final.pdf">Le dernier de nos quatre articles</a>constitue une conclusion à la série. Il évalue les enjeux stratégiques et opérationnels autour de l'épidémie et les efforts entrepris par la Riposte pour la contenir. Nous soulignons comment le manque de communication efficace, la fourniture non décisive de soins de santé gratuits et le fait de fermer les yeux sur la situation de l'époque, caractérisée par les tensions électorales et la contestation de la politique locale ont conduit à une mauvaise acceptation de ces efforts. En conséquence, la Riposte a été localement perçue par beaucoup comme une vaste machine d'extraction économique, ce qui a encore accru la méfiance des populations.</p>
<h2>Faire appel au local</h2>
<p>Sur la base de ces résultats, nous proposons des recommandations concrètes suivantes pour une meilleure gestion des épidémies.</p>
<p>Premièrement, tenir compte du contexte socioculturel, politique et économique de la région d'intervention.</p>
<p>Deuxièmement, renforcer, améliorer ou étendre le système de santé existant au lieu de créer un système parallèle qui l'affaiblit.</p>
<p>Troisièmement, écouter et intégrer les acteurs, les compétences et les pratiques locales, plutôt que de les marginaliser ou de les exclure.</p>
<p>Quatrièmement, créer des conditions favorables fournissant de l’espace aux communautés locales de s'approprier la lutte contre l'épidémie.</p>
<p>Plus profondément, nous proposons également la possibilité d’une nomenclature différente dans les épidémies, une nomenclature qui tient compte de la confiance et du devoir familial au lieu de « suspects d’Ebola » et une nomenclature qui tient compte de la dignité et du respect et non par exemple les « enterrements dignes et sécurisés ».</p>
<p>Il faudra du temps pour changer tout cela. Mais cela doit arriver. Comme beaucoup de Congolais l'ont fait remarquer lors de la 10e épidémie, « les communautés voient beaucoup plus loin que la Riposte ».</p><img src="https://counter.theconversation.com/content/178170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>La gestion internationale des épidémies, consiste parfois à céder leur contrôle à un groupe d'experts étrangers qui possèdent une compréhension superficielle d’une région très complexe.Rachel Niehuus, Surgeon and medical anthropologist, Emory UniversityBen Radley, Lecturer in International Development, University of BathBienvenu Mukungilwa, Researcher at the Centre de recherches Universitaires du Kivu (CERUKI)Christoph Vogel, Research Director of the Insecure Livelihoods Project, Ghent UniversitySerge Kambale Sivyavugha, Researcher, Université catholique de BukavuLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1721552022-02-24T19:13:17Z2022-02-24T19:13:17ZWe want to know where COVID came from. But it’s too soon to expect miracles<figure><img src="https://images.theconversation.com/files/448203/original/file-20220224-23-1h2z9vg.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/sarscov2-coronavirus-virus-which-causes-covid19-1688912314">Shutterstock</a></span></figcaption></figure><p>About two years into the pandemic, we’re still trying to find where and how it all started. Only last week, <a href="https://www.nature.com/articles/s41586-022-04532-4">we heard</a> bats in Laos may hold a clue about the origin of SARS-CoV-2, the virus that causes COVID.</p>
<p>Our interest in viral origins, especially pandemic viruses, is understandable. But we need to remember one key lesson from history. It can take years to pin down their animal source. </p>
<p>Here’s why it’s important to keep trying and – in the case of the origin of SARS-CoV-2 – why it’s too soon to expect miracles.</p>
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Read more:
<a href="https://theconversation.com/i-was-the-australian-doctor-on-the-whos-covid-19-mission-to-china-heres-what-we-found-about-the-origins-of-the-coronavirus-155554">I was the Australian doctor on the WHO's COVID-19 mission to China. Here's what we found about the origins of the coronavirus</a>
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<h2>We can learn from the past</h2>
<p>Emerging infectious diseases like COVID are becoming an <a href="https://theconversation.com/how-do-viruses-mutate-and-jump-species-and-why-are-spillovers-becoming-more-common-134656">increasing problem</a>. Most are zoonotic. In other words, they originate in non-human animals, <a href="https://www.nature.com/articles/nature06536">mainly wildlife</a>. </p>
<p>However, identifying these animal sources and how the viruses entered human populations is difficult. This is a major problem. </p>
<p>If we can identify sources and routes of spillover, then we should be better able to understand the processes driving emergence of new diseases. This means we could better predict when and where spillover is likely to occur in the future. </p>
<p>Understanding the underlying processes would also help us devise strategies to either reduce the risk of wildlife diseases transferring to humans, or to nip spillover in the bud before an epidemic or pandemic occurs.</p>
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Read more:
<a href="https://theconversation.com/how-do-viruses-mutate-and-jump-species-and-why-are-spillovers-becoming-more-common-134656">How do viruses mutate and jump species? And why are 'spillovers' becoming more common?</a>
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<h2>This is all very hard, but predictably so</h2>
<p>In the case of SARS-CoV-2, some people say scientists’ inability so far to identify the source wildlife population and to definitely say how the virus entered human populations suggests the virus originated in a laboratory. Yet <a href="https://www.sciencedirect.com/science/article/pii/S0092867421009910">the lab origin theory has been thoroughly debunked</a>.</p>
<p>However, this delay in finding definitive answers is not unusual. For many recently emerged human viruses, the wildlife source (the natural <a href="https://wwwnc.cdc.gov/eid/article/8/12/01-0317_article">reservoir</a>) took years to identify, or is still rather unclear.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1460224993334280192"}"></div></p>
<p>For example, <a href="https://www.hopkinsmedicine.org/ebola/about-the-ebola-virus.html">Ebola</a> has caused devastating outbreaks of deadly haemorrhagic disease in Africa since the 1970s. </p>
<p>Most scientists think <a href="https://www.embopress.org/doi/full/10.15252/emmm.201404792">bats are the reservoir</a>. Yet no one has yet successfully isolated Ebola virus from a wild bat, despite lots of circumstantial evidence.</p>
<h2>How about bats and COVID?</h2>
<p>The <a href="https://www.nature.com/articles/s41586-022-04532-4">closest known animal virus</a> to SARS-CoV-2 occurs in a species of horseshoe bat found throughout China and Southeast Asia. That virus is called RaTG13.</p>
<p>Although RaTG13 and SARS-CoV-2 are <a href="https://www.nature.com/articles/s41586-022-04532-4">96.1% similar</a> in their genetic code overall, this does not necessarily mean the human SARS-CoV-2 came directly from those bats. </p>
<p>In the same way, while <a href="https://bmcgenomics.biomedcentral.com/articles/10.1186/s12864-020-06962-8">chimpanzees are the closest living relatives of humans</a>, we definitely did not descend from chimpanzees, nor did chimpanzees descend from us.</p>
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<img alt="Chimpanzee mother kissing chimpanzee child" src="https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448195/original/file-20220224-23-hgznkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The DNA of chimpanzees and humans is almost identical. But that doesn’t mean we are directly related.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-chimpanzee-baby-on-mangrove-trees-353063024">Shutterstock</a></span>
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<p>Genetic similarity between two species tells us they are connected in a “family tree” to a common ancestor. The extent of that similarity gives some information about how long it was since the two species arose from that ancestor. </p>
<p>For SARS-CoV-2 and the bat coronavirus RaTG13, this separation likely occurred <a href="https://www.sciencedirect.com/science/article/pii/S0092867421009910">some decades ago</a>.</p>
<h2>Viral family trees have ‘tangles’</h2>
<p>To make things more complex, some viruses can also acquire genetic changes via <a href="https://www.nature.com/articles/nrmicro2614">recombination</a>. This occurs when two different virus strains or species infect the same cell. They can swap bits of genetic code with each other, producing a “mosaic” virus. This means the “family tree” becomes more like a tangle of brushwood.</p>
<p>So, rather than looking for a single coronavirus as the ancestor of SARS-CoV-2, we need to look at a whole range of related viruses that might co-occur in nature.</p>
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<p>More evidence for this came just last week, in a <a href="https://www.nature.com/articles/s41586-022-04532-4">paper</a> published in the prestigious journal Nature. </p>
<p>It found previously unknown bat viruses in Laos that are not quite as closely related to SARS-CoV-2 as RaTG13 overall. But some of these bat viruses from Laos are more closely related to SARS-CoV-2 than RaTG13 at the particular region that allows the virus to bind to human cells.</p>
<p>This means SARS-CoV-2 likely arose from mixing of different bat coronaviruses in natural bat populations. This is likely how SARS-CoV-2 acquired the genetic sequence that allows it to bind to human cells and infect humans.</p>
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Read more:
<a href="https://theconversation.com/why-it-will-soon-be-too-late-to-find-out-where-the-covid-19-virus-originated-166743">Why it will soon be too late to find out where the COVID-19 virus originated</a>
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<h2>What about pangolins?</h2>
<p>Pangolins are scaly mammals considered a delicacy in parts of Asia and are severely endangered by the wildlife trade. There has been a <a href="https://www.sciencedirect.com/science/article/pii/S0960982220303602">lot of discussion</a> about the possibility pangolins may have been a bridge species that enabled the transfer of this coronavirus from bats to humans.</p>
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<p>These ideas arose because we know some highly pathogenic (disease causing) emerging viruses in humans do indeed have a bridge host. Bats infect them and they, in turn, pass the virus to humans. </p>
<p>For example, we work on <a href="https://theconversation.com/explainer-why-is-hendra-virus-so-dangerous-2083">Hendra virus</a> in Australia, where <a href="https://royalsocietypublishing.org/doi/10.1098/rspb.2014.2124">horses act as a bridge host</a>. Flying foxes (a type of bat) infect horses, which in turn, infect humans. </p>
<p>Similarly, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2020.552909/full">MERS</a> (Middle East respiratory syndrome) is caused by a coronavirus of bats which has passed to camels and then on to humans.</p>
<p>With the new coronaviruses detected in bats in Laos, our understanding of the role of pangolins has changed. It appears both pangolins and humans <a href="https://www.nature.com/articles/s41586-022-04532-4">are infected by</a> coronaviruses derived from bats, but the human virus did not come via pangolins. </p>
<h2>How did a coronavirus get from bats in caves to humans in Wuhan?</h2>
<p>This critical question <a href="https://www.sciencedirect.com/science/article/pii/S0092867421009910">remains a mystery</a>. People go into the caves where these horseshoe bats live, often to collect guano (bat faeces) for fertiliser. But the nearest bat caves are some distance from Wuhan. </p>
<p><a href="https://www.nature.com/articles/s41598-021-91470-2">No bats were sold</a> in the Wuhan wet market that many of the earliest cases were linked to. </p>
<p>However, Wuhan is a major city and transport hub. So an infected person who had been in those caves may well have passed through Wuhan, and visited the wet markets. </p>
<p>SARS-CoV-2 is now known to infect a wide range of other mammals. So it is also possible a bat or a human may have infected another mammal, which then passed through the Wuhan wet market.</p>
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Read more:
<a href="https://theconversation.com/new-preliminary-evidence-suggests-coronavirus-jumped-from-animals-to-humans-multiple-times-168473">New preliminary evidence suggests coronavirus jumped from animals to humans multiple times</a>
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<h2>What do we still want to know?</h2>
<p>Lessons learnt from other viruses meant that early on in the SARS-CoV-2 outbreak, we had a solid basis for hypothesising the virus had links to bats and quite possibly arose through a bridging host in the wildlife market. </p>
<p>We still have unanswered questions about the path the virus took from bats to humans. But the more we continue to look in bat populations, the more we find these pieces of SARS-CoV-2 genetic code already exist in nature. </p>
<p>As with other emerging viruses, if we keep looking, we may eventually find all the missing pieces we need to close the case on where SARS-CoV-2 came from. If we’re smart, we’ll use this information to take action to prevent the next pandemic.</p><img src="https://counter.theconversation.com/content/172155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hamish McCallum receives funding from ARC, and the US agencies NSF, NIH and DARPA.
</span></em></p><p class="fine-print"><em><span>Alison Peel receives funding from ARC, and the US agencies NSF and DARPA. </span></em></p>The delay in finding definitive answers to how novel infectious diseases come about is not unusual. Look at what happened to our search for Ebola virus.Hamish McCallum, Director, Centre for Planetary Health and Food Security, Griffith UniversityAlison Peel, Senior Research Fellow in Wildlife Disease Ecology, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774012022-02-21T14:22:22Z2022-02-21T14:22:22ZLassa fever detected in the UK – here’s what you need to know<figure><img src="https://images.theconversation.com/files/447492/original/file-20220221-28-mieeq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around 20% of patients may experience severe illness from the Lassa fever virus.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/lassa-fever-viruses-3d-illustration-rnaviruses-1113384938">Kateryna Kon/ Shutterstock</a></span></figcaption></figure><p>Three people in the UK have <a href="https://www.gov.uk/government/news/lassa-fever-cases-identified-in-england-following-travel-to-west-africa-1">tested positive for Lassa fever</a> – including a <a href="https://www.bbc.co.uk/news/uk-england-beds-bucks-herts-60353207">newborn infant</a>, who has unfortunately died as a result. Hundreds of close-contact healthcare workers are now in isolation as a precaution. This is the <a href="https://www.gov.uk/government/news/lassa-fever-cases-identified-in-england-following-travel-to-west-africa-1">first time since 2009</a> that cases of the virus have been reported in the UK.</p>
<p>The patients are said to have contracted the virus in west Africa, where there has been a wave of infections <a href="https://www.who.int/emergencies/disease-outbreak-news/item/lassa-fever---nigeria">reported in Nigeria</a>. Many people are understandably concerned about this virus, especially given no vaccines exist against it and there are limited antiviral medicines to treat the infection it causes. But in the UK, given the small number of people that have been affected, the threat to the wider community is low.</p>
<p>Despite the recent news coverage, we’ve actually known about Lassa fever for over 50 years – though it’s likely been around much longer. The Lassa fever virus (which causes Lassa fever disease) was <a href="https://www.cdc.gov/vhf/lassa/index.html#:%7E:text=The%20illness%20was%20discovered%20in,therefore%2C%20these%20estimates%20are%20crude.">first discovered in 1969</a> during an outbreak in Nigeria. It was named after the town Lassa in the north east near Cameroon, where the outbreak first began.</p>
<p>Lassa fever is what is called a “viral haemorrhagic fever”, similar to Ebola. But while it can cause problems with how you control the movement of fluids through your body (meaning fluid may sometimes leak out of the blood vessels), this rarely happens. Thankfully, around <a href="https://www.cdc.gov/vhf/lassa/symptoms/index.html">80% of people</a> don’t get very sick when they contract Lassa fever, and usually only experience flu-like symptoms, such as a headache, sore throat and fever. </p>
<p>But in around 20% of patients, severe illness can happen. This can affect the body’s organs, including the liver, brain, gut and lungs. If you manage to survive this severe form of the disease, it’s highly likely you may experience long term disability – such as hearing loss. </p>
<p>For <a href="https://www.gov.uk/guidance/lassa-fever-origins-reservoirs-transmission-and-guidelines#:%7E:text=Lassa%20virus%20is%20a%20member,consequence%20infectious%20disease%20(%20HCID%20).">around 1%-3% of cases</a>, Lassa fever is fatal. Unfortunately, we don’t yet understand why some people get severe disease and no clear risk factors are established. </p>
<h2>Rat-borne virus</h2>
<p>Lassa fever causes an estimated 5,000 deaths a year, and up to <a href="https://www.who.int/emergencies/diseases/lassa-fever/geographic-distribution.png?ua=1">300,000 infections</a> throughout west Africa, where the disease in endemic. </p>
<p>Lassa fever is a zoonotic virus, meaning it comes from animals. It’s naturally found in a type of common wild mouse-like mammal called a <a href="https://www.cdc.gov/vhf/lassa/transmission/index.html">multimammate rat</a> that can live in close contact with humans. While the virus doesn’t usually cause illness in these rats, it can be excreted in their urine and saliva. </p>
<figure class="align-center ">
<img alt="Close-up of multimammate rat's head and upper body." src="https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447494/original/file-20220221-15-1s17to.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The virus is spread in the urine and saliva of wild rats.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/southern-multimammate-mouse-373503298">Marek Velechovsky/ Shutterstock</a></span>
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</figure>
<p>After coming in contact with affected urine or saliva, a person can be exposed to the virus if they touch their eyes, mouth or any scratches they may have. You can also inhale it through contaminated dust particles. Infection is most common during the west African dry season, between December and April. </p>
<p>Given its relatively long incubation period of one to two weeks, Lassa can easily hitch a ride in people across the world from its home in west Africa. But once a person has been exposed, they typically don’t pass it along to other people. </p>
<p>However, it has sometimes been known to spread when people are in close contract, especially if they’re exposed to contaminated fluids. While such contact between carers and contaminated fluid from patients is uncommon, great care is still taken in treating patients sick with the disease. You’re most likely to spread Lassa if you become severely ill from it.</p>
<p>Given how dangerous Lassa fever disease is, work with the virus must be carried out at the highest level of biological safety. Only a handful of labs are capable of working with Lassa fever virus, which may be why so few <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322784/">antiviral drugs</a> have been developed. No vaccine has currently been developed for Lassa Virus, and so health authorities have named it a priority disease for researchers developing ways to combat infection.</p>
<p>Lassa virus already causes considerable burden across Africa. We should expect to see more cases of Lassa outside the area as international travel takes off after the pandemic. However, with the right precautions, it’s unlikely major outbreaks will take place outside of endemic areas. This is because people outside of these regions have little contact with the infected animals.</p>
<p>The UK patients who contracted the virus will be cared for until they recover. Close contacts will continue to be closely monitored and tested for infection. If further positives are detected, they too will be isolated and contacts quarantined – similar to what occurs with COVID. But it’s unlikely that there’s much of a cause for concern for the wider public, except for those who may travel to the affected countries.</p><img src="https://counter.theconversation.com/content/177401/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Connor Bamford receives funding from Wellcome-Trust, UKRI and BMA Foundation.</span></em></p>Given the small number of people that have been affected, the threat to the wider community is low.Connor G G Bamford, Research Fellow, Virology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1752482022-02-13T07:14:37Z2022-02-13T07:14:37ZLessons from the DRC’s 10th Ebola epidemic: the people may know best<figure><img src="https://images.theconversation.com/files/442743/original/file-20220126-39683-12vvtag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The large public health apparatus assembled to fight Ebola created more problems. </span> <span class="attribution"><span class="source">Alexis Huguet/AFP via Getty Images</span></span></figcaption></figure><p>The tenth Ebola epidemic in the Democratic Republic of the Congo (DRC) was declared in North Kivu on 1 August 2018. The international response to the epidemic was significant. More than half a <a href="https://www.liberation.fr/planete/2020/02/04/en-rdc-la-riposte-de-l-oms-rattrapee-par-l-ebola-business_1776970/">billion dollars</a> of international aid flowed into the country. A newly approved, highly protective vaccine was used, and new medicines were tested and found to reduce mortality. </p>
<p>But still, on 25 June 2020, when the epidemic was finally declared over, it had become the largest Ebola outbreak ever to affect the DRC. It was also the second largest and longest globally to date, <a href="https://www.who.int/news/item/25-06-2020-10th-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-over-vigilance-against-flare-ups-and-support-for-survivors-must-continue">claiming 2,287 lives across a 23-month period</a>.</p>
<p>The large public health apparatus assembled to fight Ebola created problems, including <a href="https://www.reuters.com/article/congo-ebola-sexcrimes-idUSL8N2L953V">sexual abuse</a>. It also generated conflict. Official counts differ, but there were likely <a href="https://cic.nyu.edu/sites/default/files/vir_ebola_report_02082021_en.pdf">between 200 and 300 episodes of violence</a> tied directly to the Ebola epidemic or the national and international Ebola response coalition, known locally as the Riposte.</p>
<p>We wanted to understand why the large public health response caused so much friction in communities. To do this, we studied the different ways that local communities and the Riposte approached Ebola prevention, treatment and after-care.</p>
<p>Analyses of humanitarian action are <a href="https://www.who.int/emergencies/crises/cod/drc-ebola-srp-v20190219-en.pdf">prone</a> to <a href="https://www.cdc.gov/mmwr/volumes/65/su/su6503a5.htm">recommend</a> ways to do international epidemic management better. In our group of papers we propose a different approach altogether. We contend that international epidemic management involves ceding control to a group of foreign experts who possess, at best, a surface-level understanding of a very complex region. And we suggest that local Congolese knowledge and institutions might have the capacity to manage an Ebola epidemic more effectively than their international counterparts.</p>
<h2>Rethinking epidemic management</h2>
<p>Our research was designed – from conception to publication – by a group of Congolese scholars. Our four recently published papers provide unique vantage points from which to view an otherwise heavily studied epidemic. When read alone, their conclusions might seem modest: careful analyses of important sites of the 10th Ebola epidemic. When taken as a whole, however, they challenge the very foundations of international epidemic management. </p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/10/swp6-muhindo-ebola-final.pdf">the first of the four papers</a>, we focus on Mangina, a town in north Kivu. This health zone was the epicentre of the outbreak. Ebola cases had been documented locally three months before the outbreak was officially declared and an international response (the Riposte) deployed. Through a careful tracing of the early chain of transmission, we found that traditional methods of minimising infection transmission were remarkably effective at controlling the spread of Ebola. These included isolating the sick and using plastic bags to bury the dead.</p>
<p>The article shows how locally developed mechanisms for prevention and care slowed down the spread of the epidemic, which exploded from 26 cases in the three months before the Riposte was deployed to 250 cases in the three months after, as people became fearful and began dispersing more widely. The Mangina case offers valuable lessons on how to foster inclusive, trusted, and accepted strategies of epidemic response.</p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/11/swp7-sivyavugha-final.pdf">the second paper</a>, we describe the Ebola testing and treatment apparatus developed by the Riposte. We illustrate the harmful effects of the Riposte’s militarised, fear-based approach to testing and treatment. This approach prompted patients to flee the Riposte, which negatively affected the rate of spread, the morbidity, and the deadliness of the epidemic. </p>
<p>We argue that if existing personnel and institutional structures had been used to manage Ebola instead of imposing new structures, decades of trust in the Congolese health system could have been used to engage the population in control measures.</p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/11/swp8-mukungilwa-final-1.pdf">the third paper</a>, we consider the challenges facing survivors. Improved treatments greatly reduced mortality during the 10th Congolese epidemic. For those who got help early, Ebola was no longer a death sentence but rather a preventable and treatable disease. And so, new measures were introduced for survivors. Survivors were given material goods when discharged from treatment; they were enrolled in support groups; and they were required to follow a very regimented health surveillance system. </p>
<p>In this paper, we demonstrate that the coercive policies and tactics of the Riposte fomented fear of survivors and reinforced the stigma attached to them. We also challenge the assumption that international humanitarian organisations should play a leading role in the reintegration of survivors back into Congolese society.</p>
<p>The <a href="https://ethuin.files.wordpress.com/2021/10/swp5-muhindo-kwiravusa-final.pdf">final paper</a> serves as a conclusion to the quartet. It assesses the strategic and operational challenges around the outbreak and the efforts undertaken by the Riposte to contain it. We highlight how the lack of efficient communication, the uncritical provision of free healthcare, and a blind eye to the prevailing situation of electoral tensions and contested local politics led to poor acceptance of these efforts. As a result, the Riposte was perceived by many locally as a vast machine of economic extraction, further heightening mistrust.</p>
<h2>Bringing in the local</h2>
<p>Based on these findings, we offer concrete recommendations for improved epidemic management. </p>
<p>First, take into account the socio-cultural, political and economic context in the region of intervention. </p>
<p>Second, strengthen, improve or extend the existing health system instead of creating a parallel system that weakens it. </p>
<p>Third, listen to and integrate local actors, skills and practices, rather than marginalise or exclude them. </p>
<p>Fourth, create favourable conditions that provide space for local communities to take ownership of the fight against the epidemic.</p>
<p>More radically, we also propose the possibility of a different form of accounting in epidemics, one that tallies trust and familial duty instead of “Ebola suspects”, that counts dignity and respect rather than “secure burials completed”.</p>
<p>It will take time to change all this. But it must happen. As many a Congolese remarked during the 10th epidemic, “the people see further than the Riposte”.</p><img src="https://counter.theconversation.com/content/175248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>International epidemic management involves ceding to foreign experts who possess, at best, a surface-level understanding of a very complex region.Rachel Niehuus, Surgeon and medical anthropologist, Emory UniversityBen Radley, Lecturer in International Development, University of BathBienvenu Mukungilwa, Researcher at the Centre de recherches Universitaires du Kivu (CERUKI)Christoph Vogel, Research Director of the Insecure Livelihoods Project, Ghent UniversitySerge Kambale Sivyavugha, Researcher, Université catholique de BukavuLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1732042021-12-07T20:19:29Z2021-12-07T20:19:29ZWildlife trade poses health threats to humans, but Chinese wildlife farms are profiting<figure><img src="https://images.theconversation.com/files/435945/original/file-20211206-138695-16h9zx4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6689%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White raccoon dogs are prized for their unusual fur.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/wildlife-trade-poses-health-threats-to-humans--but-chinese-wildlife-farms-are-profiting" width="100%" height="400"></iframe>
<p>In November 2021, scientists from various disciplines published a “<a href="https://doi.org/10.1016/j.biocon.2021.109341">warning to humanity</a>” on wildlife trade because of the risk of “diseases transmitted from wildlife to humans.”</p>
<p>As COVID-19 swept across China last year, the Beijing government <a href="https://www.theguardian.com/environment/2020/feb/25/coronavirus-closures-reveal-vast-scale-of-chinas-secretive-wildlife-farm-industry">closed the live-animal sections of numerous markets and shut down 20,000 wildlife farms across the country</a>. Unknown to the outside world, however, three-quarters of the sector’s value comes from <a href="https://multimedia.scmp.com/infographics/news/china/article/3064927/wildlife-ban/index.html">breeding animals for fur, traditional medicine and entertainment purposes</a>. Many of those wildlife farms <a href="https://www.theguardian.com/environment/2020/feb/25/coronavirus-closures-reveal-vast-scale-of-chinas-secretive-wildlife-farm-industry">are still in business</a>.</p>
<p>These wildlife farms have become a focal point in the search for the origins of COVID-19, and a touchy issue for the Chinese — so much so that Beijing barred <a href="https://www.washingtonpost.com/world/asia_pacific/china-covid-bats-caves-hubei/2021/10/10/082eb8b6-1c32-11ec-bea8-308ea134594f_story.html">researchers, who were part of a mission organized by the World Health Organization (WHO), from visiting wildlife farms and bat caves in southern China</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-has-finally-made-us-recognise-the-illegal-wildlife-trade-is-a-public-health-issue-133673">Coronavirus has finally made us recognise the illegal wildlife trade is a public health issue</a>
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</p>
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<h2>Active sites</h2>
<p>In late 2020, researchers at the Belgium-based Humane Society International (HSI) <a href="https://www.hsi.org/news-media/fur-farm-investigation-reveals-distressed-foxes-raccoon-dogs-electrocuted-in-agony-and-fur-farm-carcasses-sold-for-human-consumption/">visited 13 fur farms across China</a>. The researchers found that not only were animals still being killed, but that <a href="https://www.hsi.org/news-media/fur-farm-investigation-reveals-distressed-foxes-raccoon-dogs-electrocuted-in-agony-and-fur-farm-carcasses-sold-for-human-consumption/">no measures were being taken to prevent the spread of COVID-19</a>:</p>
<p>“The fur farms we visited did not follow health and safety regulations,” says Wendy Higgins, director of international media at HSI. “Epidemic control rules were breached and our investigators were welcomed to the farms without having to follow basic biosecurity measures like disinfection stations at entry and exit points, wearing safety clothing, and having a quarantine area for ill animals,” says Higgins.</p>
<p>In March 2021, the WHO concluded that the novel coronavirus was most likely transmitted to humans through an “intermediary” rather than through <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/origins-of-the-virus">direct infection by bats, packaged food or a laboratory accident</a>. </p>
<p>The WHO researchers identified mink, civets and raccoon dogs as possible “<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/origins-of-the-virus">intermediary host species</a>,” with mink being “highly susceptible” to COVID-19. While the focus so far has been on the risk posed by humans consuming meat from these animals, the WHO report notes that direct contact with infected animals or their body waste can also spread the virus.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/origin-of-the-covid-19-virus-the-trail-of-mink-farming-155989">Origin of the Covid-19 virus: the trail of mink farming</a>
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<h2>Livestock or wildlife?</h2>
<p>Concerns about these animals’ role in spreading COVID-19 have been fuelled by <a href="https://doi.org/10.1126/science.abe3870">outbreaks at 431 mink fur farms across Europe and North America</a>. </p>
<p><a href="https://www.hsi.org/news-media/denmark-calls-for-total-mink-cull-on-all-fur-farms-amidst-covid-19-infections/">Denmark</a> <a href="https://www.ciwf.eu/news/2020/09/white-smoke-from-warsaw-poland-set-to-ban-fur-farming">and Poland</a>, the world’s top two fur-producing countries after China, have temporarily banned mink farming because of COVID-19 concerns. British Columbia will <a href="https://globalnews.ca/news/8353156/bc-mink-farm-industry-update/">phase out mink farming by 2025</a>, and France <a href="https://www.rfi.fr/en/france/20211118-france-approves-tough-new-laws-targeting-animal-cruelty-banning-wild-animal-entertainments">recently banned mink farming</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/gy-iUROpXfo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">B.C. plans to end mink farming by 2025.</span></figcaption>
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<p>China farmed an estimated <a href="https://www.independent.co.uk/stop-the-illegal-wildlife-trade/covid-fur-farms-china-b1855584.html">14 million foxes, 13.5 million raccoon dogs and 11.6 million mink in 2019</a>. But rather than ban fur farming, the Chinese government classified <a href="http://forestry.gov.cn/bwwz/2784/20200513/085630366321198.html">mink, foxes and raccoons as livestock</a>, explicitly excluding them from the wildlife ban.</p>
<p>“Virologists are concerned the virus can lay dormant at fur farms. The virus is capable of mutating so as we develop vaccines, new variants can emerge that are resistant. To leave such a potential threat untouched, just to boost the world of fashion, seems a far too great risk,” says Higgins.</p>
<p>In May 2020, Chinese authorities <a href="https://www.chinanews.com/gn/2020/05-16/9186245.shtml">offered buyouts to farmers who raise wildlife for food</a>, but the same incentive was not offered to fur farmers. Recent data is hard to come by, but in 2016, fur farming was valued at an <a href="https://multimedia.scmp.com/infographics/news/china/article/3064927/wildlife-ban/index.html">estimated 389 billion Chinese yuan (US$55 billion), as opposed to only 125 billion yuan (US$17 billion) for wildlife food production</a>.</p>
<h2>Luxury and profits</h2>
<p>As a result of the closure of fur farms in other parts of the world, Chinese producers <a href="https://www.reuters.com/article/us-health-coronavirus-china-mink-idUSKBN28D0PV">experienced a price hike of 30 per cent</a> in December 2020. </p>
<p>Wildlife is considered a luxury product affordable only to a small but <a href="https://www.brookings.edu/wp-content/uploads/2020/07/8_Felbab-Brown_China_final.pdf">growing segment of consumers</a>. A World Wildlife Fund survey found that <a href="https://globescan.com/wp-content/uploads/2021/05/WWF-GlobeScan-COVID19_One_Year_Later-Highlights_Report-May2021.pdf">in China, 10 per cent of respondents had purchased wild animals at an open market in 2019</a>. </p>
<p>Worryingly, scientists found that banning wildlife markets has “<a href="https://doi.org/10.1016/j.envres.2020.110439">not discouraged online wildlife trade</a>.”</p>
<p>Besides food and fur, wild animal parts are also used in traditional Chinese medicine, a growing market actively promoted by the government. Chinese consumers were <a href="https://www.theguardian.com/environment/2020/may/26/its-against-nature-illegal-wildlife-trade-casts-shadow-over-traditional-chinese-medicine-aoe">expected to spend US$420 billion annually on these items by the end of 2020</a>.</p>
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<a href="https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older women sit in front of a window display of a traditional Chinese medicine shop" src="https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436039/original/file-20211207-141178-gta8uc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A group of women sit in front of a window display of a traditional Chinese medicine shop. The growing demand for traditional Chinese medicine has fed the legal and illegal trade in exotic animal parts.</span>
<span class="attribution"><span class="source">(AP Photo/Ng Han Guan)</span></span>
</figcaption>
</figure>
<p>China legalized the use of <a href="https://www.nationalgeographic.com/animals/article/wildlife-watch-news-china-rhino-tiger-legal">rhino horn and tiger bone in traditional medicine in 2018</a>. It went further last year with a <a href="https://www.theguardian.com/world/2020/jun/03/beijing-draws-up-plans-to-outlaw-criticism-of-traditional-chinese-medicine">law criminalizing any public criticism of traditional medicine</a>. More recently, the government started <a href="https://www.nationalgeographic.com/animals/article/chinese-government-promotes-bear-bile-as-coronavirus-covid19-treatment">promoting the use of traditional medicine to cure COVID-19</a> without any evidence to that effect.</p>
<h2>Mitigation and policy</h2>
<p>The government’s policy towards wildlife farming echoes its actions during the SARS outbreak in 2003. It initially <a href="https://doi.org/10.1016/S1473-3099(06)70676-4">shut down wildlife markets</a> when the disease was traced to animals, but after two years, enforcement “<a href="https://www.brookings.edu/wp-content/uploads/2020/07/8_Felbab-Brown_China_final.pdf">lessened as the wildlife trade industry lobbied against it and pointed out the economic and job contributions to the country</a>.” </p>
<p>The WHO continues its search for the definitive origin of COVID-19. It recently announced the formation of a <a href="https://www.who.int/news-room/articles-detail/public-notice-and-comment-on-proposed-new-scientific-advisory-group-for-the-origins-of-novel-pathogens-(sago)-members">scientific advisory group to further the investigation</a>, and has <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/origins-of-the-virus">recommended conducting “targeted surveys of fur farms” as one line of inquiry</a>.</p>
<p>Despite close encounters with Ebola, SARS-CoV-1, Middle East Respiratory Syndrome and H1N1, and decades of warnings from <a href="https://doi.org/10.1089/vbz.2020.2652">infectious diseases specialists</a>, stricter regulation and additional mitigation strategies are needed.</p><img src="https://counter.theconversation.com/content/173204/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anrike Visser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In China, the wildlife trade is thriving, driven by the increased demands for luxury goods and traditional medicine. But there is real concern about the threat of diseases that can cross over to humans.Anrike Visser, Dalla Lana Global Journalism Fellow, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676172021-11-03T12:29:25Z2021-11-03T12:29:25ZPreventing future pandemics starts with recognizing links between human and animal health<figure><img src="https://images.theconversation.com/files/427568/original/file-20211020-19033-hhgo6g.jpg?ixlib=rb-1.1.0&rect=18%2C6%2C2008%2C1526&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disturbing the habitats of horseshoe bats, like these in Borneo, increases the risk of virus spillover.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/nhwHdN">Mike Prince/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The COVID-19 pandemic has demonstrated that zoonotic diseases – infections that pass from animals to humans – can present tremendous threats to global health. More than 70% of emerging and reemerging pathogens <a href="https://www.worldbank.org/en/news/feature/2020/07/09/qa-how-preventing-zoonotic-diseases-can-help-curb-covid-19-and-other-infectious-diseases">originate from animals</a>. That probably includes the SARS CoV-2 virus, which scientists <a href="http://dx.doi.org/10.1126/science.abh0117">widely believe originated in bats</a>. </p>
<p>There are still questions about specifically where the SARS-CoV-2 virus emerged. But experts across the globe agree that communities can take steps to reduce the risk of future spillovers. A key is for veterinarians, doctors and scientists to work together, recognizing how closely connected human health is with that of animals and of the habitats that we share – an approach known as <a href="https://www.cdc.gov/onehealth/basics/index.html">One Health</a>.</p>
<p>To prevent new pandemics, scientists need to identify specific locations where viruses are most likely to make the jump from animals to humans. In turn, this requires understanding how human behaviors – from deforestation to fossil fuel combustion to conflict to cultural activities – contribute to spillover risks. </p>
<p>We focus on <a href="https://vetprofiles.tufts.edu/profile/deborah-t-kochevar/">global One Health research and education</a> and <a href="https://www.researchgate.net/profile/Guilherme-Werneck">epidemiology of infectious diseases</a>, and we served on a science task force convened by the Harvard T.H. Chan School of Public Health and the Harvard Global Health Institute to evaluate current knowledge of how to prevent spillovers. The <a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2343/2021/08/PreventingPandemicsAug2021.pdf">task force report</a> noted that a <a href="http://dx.doi.org/%2010.1126/science.abc3189">recent analysis</a> estimates the costs of addressing spillover at high-risk interfaces through One Health approaches and forest conservation at US$22 billion to $31 billion per year. These costs are dwarfed by the estimated global <a href="https://www.oecd-ilibrary.org/economics/oecd-economic-outlook/volume-2021/issue-1_edfbca02-en">GDP loss of nearly $4 trillion</a> in 2020 due to the COVID-19 pandemic. </p>
<p>In our view, coordinated investment based on a One Health approach is needed to initiate and sustain global prevention strategies and avoid the devastating costs of pandemic response.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic naming specialties that contribute to One Health." src="https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427570/original/file-20211020-19-1cj0tz0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One Health is a strategy that seeks to build bridges connecting physicians, veterinarians, environmental scientists, public health professionals and other specialists to protect the health of all species.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/onehealth/images/social-media/one-health-involves-everyone-fb-tw.jpg">CDC</a></span>
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<h2>Recognizing risky zones</h2>
<p>Identifying high-risk areas for zoonotic spillover is challenging. People and wildlife move around a lot, and exposure may not lead immediately to infection or produce symptoms that clearly reflect exposure to pathogens. </p>
<p>But researchers can make predictions by combining data on human and livestock density with that on environmental conditions, such as deforestation and land use changes, that can enable pathogens to spread from wildlife to humans. For instance, there are areas in China, Indonesia, India and Bangladesh where development has fragmented forests and extended animal farming and human communities near the natural habitats of <a href="https://www.britannica.com/animal/horseshoe-bat">horseshoe bats</a>. This group of bats, which includes more than 100 species, has been implicated as a reservoir for many coronaviruses. </p>
<p>It’s not uncommon for bat-borne diseases to spill over to humans. Sometimes it happens directly: For example, bats in Bangladesh have repeatedly transmitted <a href="https://doi.org/10.1073/pnas.2000429117">Nipah virus</a> to humans. Or the pathogen can move indirectly via intermediate hosts. For example, in 1994 bats in Australia infected horses with Hendra virus, a respiratory disease that <a href="http://dx.doi.org/10.3201/eid1602.090780">then passed to humans</a>.</p>
<p>In Brazil, yellow fever is endemic in the jungles, spread mainly between monkeys via mosquitoes. People in the country occasionally contract it from mosquito bites, and deforestation and land conversion for farming are increasing the risk of greater spillovers. There is rising concern that the disease could be introduced into Brazil’s large cities, where <em>Aedes aegypti</em> mosquitoes are widespread and could <a href="https://doi.org/10.1038/s41598-017-05186-3">transmit it on a large scale</a>. </p>
<p>There also are specific human behaviors that may further increase the risk of spillovers. They include work that puts humans in direct contact with or near animals, such as <a href="https://www.batcon.org/article/guano-bats-gift-to-gardeners/">harvesting bat guano (dung) for fertilizer</a>, and <a href="https://theconversation.com/the-new-coronavirus-emerged-from-the-global-wildlife-trade-and-may-be-devastating-enough-to-end-it-133333">buying and selling wild animals or animal parts</a>. </p>
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<figcaption><span class="caption">Tropical deforestation, wildlife trade and raising livestock near forest edges are thought to be major drivers of zoonotic disease spillover.</span></figcaption>
</figure>
<p>Daily routines related to storing food and eating wildlife meat can also create risks. For example, Ebola virus outbreaks in Nigeria have been associated with <a href="https://doi.org/10.1007/s10935-020-00619-8">butchering and eating bushmeat</a>. </p>
<p>People in areas with a high risk of spillover don’t need to stop living their lives. But they do need to recognize that some actions are more risky than others and take appropriate safety precautions, such as wearing protective equipment and making sure that bushmeat is properly handled and cooked.</p>
<h2>The importance of teamwork</h2>
<p>In our view, it is essential for researchers and governments to understand and embrace the central concept that the health of animals, people and the environment is closely connected, and factors that affect one can affect all. Ideally, problem-solving teams form that address prevention from the community and district levels to the ranks of health, animal and environmental ministries.</p>
<p>Members of local communities are most likely to know where people run the highest risk of coming in contact with animals that may carry infectious diseases. By listening to them, veterinary and medical health professionals, as well as foresters and land managers, can develop strategies that are more likely to decrease the risk of spillover.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Technician in protective suit takes blood sample from a camel." src="https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428587/original/file-20211026-19-1mcpdvb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Camels infected with Middle East respiratory syndrome coronavirus (MERS-CoV) can pass the virus to humans through direct or indirect contact. Since 2012 MERS has killed more than 800 people in the Middle East, Africa and South Asia. Testing is an important tool for detecting infected animals.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/Y67Jos">Awadh Mohammed Ba Saleh, CDC Global/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Organizations such as the <a href="https://pdf.usaid.gov/pdf_docs/PA00TTB3.pdf">U.S. Agency for International Development</a>, the <a href="https://www.fao.org/emergencies/fao-in-action/stories/stories-detail/en/c/1418052/">Food and Agriculture Organization of the United Nations</a>, <a href="https://www.health.go.ug/cause/uganda-one-health-strategic-plan-2018-2022/">national governments</a> and <a href="https://onehealthbd.org/">civil society groups</a> are investing in One Health platforms across selected countries in Africa and Asia. These networks are typically anchored in government ministries. They can also include nongovernmental organizations and civil society groups committed to advancing health and well-being through a One Health framework.</p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>For example, many countries have separate databases to track infectious disease outbreaks in humans and animals. Connecting these systems across government ministries and agencies can improve information exchange between them and lead to better understanding of spillover risks. </p>
<p>We believe that preparing for the next pandemic must include preventing it at its source. Our best chance to succeed is to coordinate research and design of spillover interventions, recognizing that the health of humans, animals and nature are connected.</p><img src="https://counter.theconversation.com/content/167617/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Kochevar receives funding from the U.S. Agency for International Development. She is a member of the boards of Charles River Laboratories and Elanco, a pharmaceutical company that produces medicines and vaccinations for pets and livestock. </span></em></p><p class="fine-print"><em><span>Guilherme Werneck receives funding from The Brazilian Research Council (CNPq) and the Carlos Chagas Filho Foundation for Research Support in the State of Rio de Janeiro (FAPERJ). </span></em></p>How can nations prevent more pandemics like COVID-19? One priority is reducing the risk of diseases’ jumping from animals to humans. And that means understanding how human actions fuel that risk.Deborah Kochevar, Professor of Comparative Pathobiology and Dean Emerita, Cummings School of Veterinary Medicine; Senior Fellow, The Fletcher School, Tufts UniversityGuilherme Werneck, Professor of Epidemiology, Universidade Federal do Rio de Janeiro (UFRJ)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1691972021-10-18T14:28:46Z2021-10-18T14:28:46ZCOVID-19 shows why African data is key for the continent’s response to pandemics<figure><img src="https://images.theconversation.com/files/424737/original/file-20211005-23-1g7ylw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-10 pandemic followed a different path in Africa than was predicted.</span> <span class="attribution"><span class="source">Nicholas Kajoba/Xinhua via Getty Images</span></span></figcaption></figure><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235494/">Early predictions</a> of the impact of the COVID-19 pandemic by some public health scientists painted a gloomy picture for Africa. The continent was expected to suffer a huge burden of disease and death. These predictions have not held true. The continent has experienced <a href="https://www.sciencedirect.com/science/article/pii/S0305750X20303788?via%3Dihub">fewer deaths</a> than predicted.</p>
<p>In addition, it has been much less affected than many other parts of the world. For example, the total number of recorded deaths in the entire African continent is slightly less than those recorded in the UK alone. Even when under-reporting is accounted for, the mortality rate has been lower than in <a href="https://ourworldindata.org/covid-deaths">western Europe</a>. </p>
<p>There are several reasons why predictions of COVID-19 ravaging African countries were wrong – but two stand out. The first is limited scientific knowledge of how the virus behaves in different populations and environments. The second is an underestimation of Africa’s ability to respond to the pandemic. </p>
<p>Despite having comparatively poor health <a href="https://www.afro.who.int/news/who-pledges-support-african-countries-joint-coronavirus-disease-preparedness-and-response">infrastructure</a>, African public health practitioners have amassed a wealth of experience of managing epidemics. The <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">2014-16 Ebola</a> outbreak in west Africa showed local doctors using mitigation strategies available to them and the strong community based healthcare system. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-impact-of-covid-19-has-been-lower-in-africa-we-explore-the-reasons-164955">The impact of COVID-19 has been lower in Africa. We explore the reasons</a>
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<p>By September 2020, it was clear that the pandemic was following a different path on the continent than was predicted. This underscored the need for African countries to learn lessons for Africa from data collected from Africa. </p>
<p>To do this, my colleagues and I at the National Institute for Health Research Global Health Unit <a href="https://tiba-partnership.org/">Tackling Infections to Benefit Africa</a> worked with partners at the Universities of Ghana and Edinburgh, as well as the World Health Organisation (WHO) regional office for Africa, to <a href="https://www.nature.com/articles/s41591-021-01491-7">analyse data</a> collected from member states. </p>
<p>We determined the factors that influenced the timing of the first COVID-19 cases as well as the number of COVID-19 deaths in the WHO’s African member states during the first and second pandemic waves. We also looked for associations between the preparedness of health systems and government pandemic responses. </p>
<p>We found that countries with more urban populations detected their first cases of COVID-19 earlier than those with higher rural populations. Countries with high HIV prevalence reported the most COVID-19-related deaths. And countries with the most advanced health systems fared the worst in terms of COVID-19 cases and deaths. </p>
<p>Our findings helped us to understand Africa’s epidemic and provided lessons for future pandemics. </p>
<h2>A snapshot of COVID-19 in Africa</h2>
<p>In our <a href="https://www.nature.com/articles/s41591-021-01491-7">recent research</a> we investigated factors that could potentially influence the spread and severity of the COVID-19 pandemic based on the knowledge of the virus’s transmission factors and potential risk factors. We tested the effect of 15 such factors.</p>
<p>We found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity, but later in island nations. This finding is not surprising, given <a href="https://gh.bmj.com/content/6/1/e004408">what we know</a> about the transmission of the virus indoors, the introduction of SARS-CoV-2 into Africa from Europe and the importance of surveillance and testing. </p>
<p>Egypt was the <a href="https://www.afro.who.int/news/second-covid-19-case-confirmed-africa">first</a> of 47 African countries to report a case in February 2020. Most countries had recorded cases by late March 2020, with Lesotho being the last to report one, on 14 May 2020. </p>
<p>Countries with high rates of HIV were also more likely to have higher mortality rates. This was also not surprising as people with HIV often have other health conditions that put them at <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1198/5899044">greater risk</a> from COVID-19. </p>
<p>Among 44 countries of the WHO African Region with <a href="https://who.maps.arcgis.com/apps/dashboards/0c9b3a8b68d0437a8cf28581e9c063a9">available data</a>, South Africa had the highest mortality rate during the first wave between May and August 2020, at 33.3 deaths recorded per 100,000 people. Cape Verde and Eswatini had the next highest rates at 17.5 and 8.6 deaths per 100,000 respectively. At 0.26 deaths recorded per 100,000, the lowest mortality rate was in Uganda. </p>
<p>True numbers of deaths in Africa are thought to be over three times higher <a href="http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths">than officially reported</a>, slightly higher than the global average, but even accounting for this, our findings are still valid.</p>
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Read more:
<a href="https://theconversation.com/unpacking-south-africas-excess-deaths-what-is-known-and-where-the-gaps-are-167920">Unpacking South Africa's excess deaths. What is known and where the gaps are</a>
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<p>Our most important finding was that seemingly well-prepared, resilient countries such as South Africa have fared worst during the pandemic. This is not only true in Africa; the result is consistent with a global trend that more developed countries have often been particularly hard hit by COVID-19. This tells us that lack of preparedness and vulnerability are not the same thing. </p>
<p>While health systems may have been less prepared for the pandemic, other factors such as demography and rural populations made the African population less vulnerable. We are also currently investigating the potential protective role of previous exposure to other pathogens that may induce COVID-19 protective cross-immunity or modify the immune phenotype and thus, disease progression and prognosis. </p>
<p>Our analysis indicates the critical importance of using context-appropriate data in models to make predictions that guide control or mitigation policy. This would inform context-relevant interventions. The director of the WHO’s regional office for Africa, Matshidiso Moeti, <a href="https://www.ed.ac.uk/news/2021/study-challenges-pandemic-preparedness-in-africa">remarked</a>: </p>
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<p>The early models which predicted how COVID-19 would lead to a massive number of cases in Africa were largely the work of institutions not from our continent. This collaboration between researchers in Africa and Europe underlines the importance of anchoring analysis on Africa’s epidemics firmly here.</p>
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<p>The study also highlighted unanticipated vulnerabilities. For example countries with strong health systems could still be vulnerable to pandemics. Therefore, assessing the impact of potential threats and future pandemic preparedness planning must be informed by the transmission dynamics and local risk factors for infection and disease. </p>
<p>It is clear that other factors unique to Africa such as a younger population and less urbanisation have contributed to the comparatively lower COVID-19 cases and deaths on the continent. Moeti reiterated these when she said: </p>
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<p>We can no longer focus our understanding of disease transmission purely on the characteristics of a virus – COVID-19 operates within a social context which has a major impact on its spread.</p>
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<h2>Going forward</h2>
<p>Going forward, African researchers and governments need to do three things.</p>
<ul>
<li><p>First, African scientists must conduct more Africa-led analyses of Africa’s COVID-19 epidemic at national and continental level. These analyses should include studies of the impact of Africa’s socio-ecological setting and the structure of the health delivery system, which is heavily community based.</p></li>
<li><p>Second, we need to use these results to identify uniquely African strengths and vulnerabilities to emerging and epidemic disease to inform preparedness planning and ensure that epidemic preparedness indices such as the <a href="https://www.ghsindex.org/">Global Health Security Index</a> take these into account. </p></li>
<li><p>Third, we need to accelerate open data sharing to ensure timely access to data to inform data-driven innovations and interventions.</p></li>
</ul><img src="https://counter.theconversation.com/content/169197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francisca Mutapi receives funding from the National Institute for Health Research (NIHR) Global Health Research Program (16/136/33) using UK AID from the UK Government. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. </span></em></p>Despite having comparatively poor health infrastructure, African public health practitioners have amassed a wealth of experience of managing epidemics.Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1691662021-10-11T15:07:52Z2021-10-11T15:07:52ZPapers show what lay behind Condé regime’s Ebola denialism in Guinea<figure><img src="https://images.theconversation.com/files/425254/original/file-20211007-23-g2ijth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Liberia and Sierra Leone actively sought international aid to combat Ebola in 2014, Guinea downplayed the extent of the deadly disease. </span> <span class="attribution"><span class="source">EFE-EPA/Ahmed Jallanzo</span></span></figcaption></figure><p>More than 11,300 people died when the Ebola virus ripped through <a href="https://www.who.int/emergencies/situations/ebola-outbreak-2014-2016-West-Africa">three West African countries</a> – Guinea, Sierra Leone, and Liberia – from 2014 to 2016. It was the worst Ebola outbreak in known history. </p>
<p>But the differences in responses to the outbreak, particularly in its early stages, were puzzling. While the outbreak worsened during the March-October 2014 period, Liberia and Sierra Leone emphatically sought global assistance. They and other states highlighted the danger the virus posed to local, <a href="https://obamawhitehouse.archives.gov/the-press-office/2014/09/25/remarks-president-obama-un-meeting-ebola">regional and global stability</a>. Guinea’s reaction, in contrast, was to downplay the epidemic. President Alpha Condé insisted his government <a href="https://www.sciencedirect.com/science/article/pii/S2214790X20303026">had the outbreak under control</a>.</p>
<p>As it’s one of the <a href="https://www.tandfonline.com/doi/full/10.1080/02684527.2020.1750136">poorest countries in the world</a>, with little infrastructure, and virtually no health infrastructure, why would anyone believe President Condé’s assertion?</p>
<p>For me, this reaction did not appear to be in line with the severity of the outbreak, its potential economic destruction, the general risks to the population, and Guinea’s overall stability. </p>
<p>I decided to find out why Guinea reacted this way. And I <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214790X20303026">concluded</a> that the reason was fear that Ebola would panic investors. Condé’s initial response was indicative of a pattern among some leaders to prioritise the perception of political and economic health instead of the health of their citizens. As in the current pandemic, this pattern is not unique to Guinea or <a href="https://www.tandfonline.com/doi/full/10.1080/00396338.2020.1819641">to the Ebola outbreak</a></p>
<h2>Behind Guinea’s Ebola denialism</h2>
<p>In October 2014, I filed a <a href="https://www.foia.gov/">Freedom of Information Act</a> request with the US Departments of State and Defense for information and communiqués related to the Ebola outbreak from the US embassies in Conakry, Freetown and Monrovia. </p>
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<a href="https://theconversation.com/marburg-in-guinea-the-value-of-lessons-from-managing-other-haemorrhagic-outbreaks-167392">Marburg in Guinea: the value of lessons from managing other haemorrhagic outbreaks</a>
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<p>After three years of prodding and waiting, both agencies delivered sets of documents that showed a blunt assessment of events in Liberia and Sierra Leone during the March-October 2014 period.</p>
<p>But Condé told US embassy officials that Guinea had the outbreak under control. The documents presented a series of communiqués that provided assessments of the Ebola outbreaks in the three countries during the March-October 2014 period. The assessments were provided by high ranking US embassy staff, up to the level of US ambassadors. </p>
<p>What I <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214790X20303026">found</a> confirmed President Condé’s downplaying of the outbreak. It also revealed one of his potential motives in doing so. </p>
<p>The story these documents told revealed policy failures that had their roots in both Guinea’s underdevelopment and in the <a href="https://www.everycrsreport.com/files/20141219_R40703_c0408908fa72d1579006812f42d18528c2b0c125.pdf">deeply corrupt relationship</a> between mining interests and the government. </p>
<p>If you want to understand what a government’s priorities are, an examination of its budget spending can help. In 2017, the latest available data indicated that Guinea spent only 4.1% of its government budget <a href="https://databank.worldbank.org/source/world-development-indicators#">on healthcare</a>. But it spent 10.2% of its budget on its military. That number declined in 2020 to 8.2%, but was still double the healthcare expenditures.</p>
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<a href="https://theconversation.com/ebola-strikes-west-africa-again-key-questions-and-lessons-from-the-past-155566">Ebola strikes West Africa again: key questions and lessons from the past</a>
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<p>Overall, Guinea ranks 178 out of 189 countries on the World Bank’s <a href="http://hdr.undp.org/sites/default/files/hdr2020.pdf">Human Development Index</a>. The index is a composite measure of health, education and income. It’s used as a measure of human poverty and capability that extends beyond just income.</p>
<p>Guinea’s mining interests also played a role. As the Ebola epidemic was unfolding in March 2014 – after the Guinean government acknowledged the presence of the virus – corruption scandals and mining contract issues that had been simmering since Condé took office <a href="https://www.globalwitness.org/en/reports/guineas-deal-century/">finally boiled up</a>. </p>
<p>Condé’s government needed more investors to develop Guinea’s mining sector. The country is home to the world’s largest supply of high-grade bauxite, the key component in the making of aluminium, and one of the world’s <a href="https://www.azomining.com/Article.aspx?ArticleID=42">largest untapped iron ore deposits</a>.</p>
<p>For Condé, the opportunity to advance this and other projects came with the first <a href="https://obamawhitehouse.archives.gov/us-africa-leaders-summit">US-Africa Leaders Summit</a> held in Washington in August 2014. The summit was critical for kick-starting a new round of investment after the previous regime’s mining arrangements collapsed. </p>
<p>The Guinean delegation to the conference – the only one of the three Ebola-stricken countries to attend – <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214790X20303026">explained</a> that they thought the heightened attention accorded to Ebola in the run-up to the summit would unfairly refuel Guinea’s image as “too risky” and might scare off investors.</p>
<p>While the summit produced help in the Ebola crisis, Condé also conducted high level meetings with mining investors to discuss over US$20 billion in investments. </p>
<p>Ebola denialism in Guinea had its roots in a fear that Ebola would panic investors. On August 14, 2014 after the US summit, Condé ordered a national health emergency, months after the outbreak was declared. The delay in casting Ebola as a national emergency in Guinea <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214790X20303026">contributed</a> to growing infection rates and deaths in the country. </p>
<h2>Quest for power trumps public welfare</h2>
<p>Condé’s approach to the Ebola crisis and his courting of business and mining interests <a href="https://www.jstor.org/stable/723809">continued a history</a> of African leaders who employ extraversion strategies. These strategies allow elites to marshal resources and finances that are derived from their external global relationships. Such leaders have opened their economies to investors, letting them <a href="https://www.jstor.org/stable/723809">divert resources for corrupt purposes</a> that extend their political and economic control in the state.</p>
<p>Such policies provided the basis for Condé to consolidate power through a stronger patrimonial network and tighter personal and familial control over the country’s mining interests. That control gave him confidence when he sought to extend his time in office beyond the <a href="https://www.bbc.com/news/world-africa-54657359">constitutionally prescribed two terms</a>. </p>
<p>Condé got a third term in office <a href="https://www.bbc.com/news/world-africa-54657359">in 2020</a>. But his government was overthrown in a military coup <a href="https://www.bbc.com/news/world-africa-58468750">in September 2021</a>. The coup leader, Colonel Mamady Doumbouya, cited Condé’s lack of leadership, his corruption, and Guinea’s lack of development as motivation. </p>
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<a href="https://theconversation.com/guinea-coup-highlights-the-weaknesses-of-west-africas-regional-body-167650">Guinea coup highlights the weaknesses of West Africa's regional body</a>
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<p>Guinea’s lack of development, though not new, is particularly poignant as the country moves through its current COVID-19 wave, with little or no improvement in its basic and medical infrastructure. Notably, Doumbouya was quick to assure mining investors that <a href="https://www.npr.org/2021/09/06/1034587283/guineas-military-declared-coup-future-uncertain">their contracts were safe</a>. </p>
<h2>Future uncertain</h2>
<p>Condé’s pursuit of mining interests during the Ebola crisis may have foreshadowed his demise as he tightened his grip over power and <a href="https://www.africanews.com/2020/08/04/guinean-opposition-alleges-largescale-corruption-by-president-alpha-conde//">plundered the state’s wealth</a>, as many before him did.</p>
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<a href="https://theconversation.com/guinea-has-a-long-history-of-coups-here-are-5-things-to-know-about-the-country-167618">Guinea has a long history of coups: here are 5 things to know about the country</a>
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<p>While Guinea’s people were <a href="https://www.washingtonpost.com/national-security/2021/09/06/guinea-coup-explained/">happy to see him go</a>, the country’s <a href="https://oxfordre.com/politics/view/10.1093/acrefore/9780190228637.001.0001/acrefore-9780190228637-e-1894">history of corrupt leaders</a> and persistent <a href="https://www.lexafrica.com/2019/08/guinea-emerging-from-the-shadows/">underdevelopment</a> mean hope for real change may be a dream under a new military regime.</p><img src="https://counter.theconversation.com/content/169166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Ostergard, Jr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Alpha Condé’s pursuit of mining interests during the Ebola crisis may have foreshadowed his demise as he tightened his grip over power and plundered the state’s wealth.Robert Ostergard, Jr, Associate Professor of Political Science, University of Nevada, Reno, University of Nevada, RenoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1692232021-10-05T15:23:34Z2021-10-05T15:23:34ZSexual abuse during humanitarian operations still happens. What must be done to end it<figure><img src="https://images.theconversation.com/files/424670/original/file-20211005-17-1nqdcwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization (WHO) sign at its headquarters.</span> <span class="attribution"><span class="source">FABRICE COFFRINI/AFP via Getty Images</span></span></figcaption></figure><p>The World Health Organization (WHO) is under fire after allegations of sexual exploitation and abuse <a href="https://www.thenewhumanitarian.org/2020/09/29/exclusive-more-50-women-accuse-aid-workers-sex-abuse-congo-ebola-crisis">surfaced last month</a>. More than 50 women accused aid workers from several organisations of crimes that took place during the Democratic Republic of Congo’s 10th Ebola outbreak.</p>
<p>In response, the WHO <a href="https://www.who.int/news/item/15-10-2020-who-appoints-co-chairs-of-independent-commission-on-sexual-misconduct-during-the-ebola-response-in-north-kivu-and-ituri-the-democratic-republic-of-the-congo">launched</a> an independent investigation into the allegations. The investigation <a href="https://www.who.int/publications/m/item/final-report-of-the-independent-commission-on-the-review-of-sexual-abuse-and-exploitation-ebola-drc">identified</a> 83 alleged perpetrators, including 21 individuals who worked for the WHO during the Ebola response. It detailed failures of leadership by those responsible for the Ebola response and those in charge of addressing employee and partner malfeasance.</p>
<p>Unfortunately, the WHO case is just the latest in a <a href="https://www.thenewhumanitarian.org/feature/2021/2/11/25-years-of-sexual-exploitation-and-abuse">long list</a> of sexual exploitation scandals within the UN and humanitarian systems since the 1990s.</p>
<p>The <a href="https://www.un.org/">United Nations</a> and humanitarian systems, of which the WHO is a part, have sought to <a href="https://www.un.org/preventing-sexual-exploitation-and-abuse/">address</a> this <a href="https://psea.interagencystandingcommittee.org/">issue</a> for decades. This has involved <a href="https://psea.interagencystandingcommittee.org/resources?f%5B0%5D=type_of_publication%3A301">assessing</a> organisational systems, developing <a href="https://www.un.org/preventing-sexual-exploitation-and-abuse/content/tools">tools</a>, establishing <a href="https://psea.interagencystandingcommittee.org/resources?f%5B0%5D=type_of_publication%3A705">policies</a>, and <a href="https://www.un.org/preventing-sexual-exploitation-and-abuse/content/training">providing</a> <a href="https://psea.interagencystandingcommittee.org/resources?f%5B0%5D=type_of_publication%3A326">training</a>.</p>
<p>In 2010, the inter-agency standing committee, a key global humanitarian coordination mechanism, even conducted <a href="https://interagencystandingcommittee.org/protection-sexual-exploitation-and-abuse/documents-public/iasc-global-review-protection-sexual">a review</a> of member organisations to figure out how to prevent and respond to sexual exploitation and abuse. It found a lack of high-level engagement and support for this work, and inconsistent implementation of policies. A <a href="https://psea.interagencystandingcommittee.org/resources/iasc-pseah-external-review-terms-reference-2021">follow-up external review</a> is currently under way. </p>
<p>Despite all this work, the abuse of vulnerable women and children persists.</p>
<p>My <a href="https://www.researchgate.net/profile/Chen-Reis">research</a> and work on humanitarian assistance and sexual violence suggests that organisation and system culture can be a barrier to appropriate action. Humanitarian organisation leaders must prioritise prevention. In addition the relevant expertise must be deployed and humanitarian organisations must work closely with local women’s organisations. </p>
<p>Here are some key insights into how humanitarian organisations can do a better job of preventing, and responding to, sexual exploitation and abuse.</p>
<h2>Addressing sexual violence</h2>
<p><strong>The survivors and their needs should be centred in reporting, investigation and response systems.</strong></p>
<p>The WHO’s report referenced several incidents where protecting organisational reputation seemed to have been the focus, rather than removing perpetrators and supporting survivors. The experiences, needs and wants of victims and survivors must come first. </p>
<p>Reports are the tip of the iceberg and survivors <a href="https://www.researchgate.net/publication/51664415_Problems_in_Reporting_Sexual_Violence_Prevalence">face numerous barriers</a> to disclosing exploitation and abuse. Organisations must focus on the safety and well-being of victims and survivors in a timely manner. Minimising damage to the organisation and staff mustn’t be the priority.</p>
<p><strong>Strong sexual exploitation and abuse policies are essential but aren’t sufficient.</strong></p>
<p>Organisations must implement policies that govern the conduct of staff and partner organisations they work with on the ground. While the commission noted that the <a href="https://www.who.int/about/ethics/sexual-exploitation-abuse">WHO’s legal and policy framework</a> on sexual exploitation and abuse was adequate, it also found that the WHO was “completely unprepared to deal with the risks or incidents of sexual exploitation and abuse.” </p>
<p>Organisations must carry out policies to prevent and respond to sexual exploitation and abuse and hold perpetrators to account. </p>
<p>This requires political support – from member states, humanitarian and organisational leadership, and staff – and resources. Donors should generously support efforts to build robust mechanisms to prevent and respond to sexual exploitation and abuse. Funds must also be available for assisting survivors and reparations.</p>
<p><strong>More women must be included in leadership and other roles in emergency response.</strong></p>
<p>The commission’s report noted that of some 2,800 staff working for the WHO in the Ebola response, over 73% were men. Over 77% of those in leadership roles were men. All of the senior leaders who were found to have failed to live up to the WHO’s zero-tolerance policy were men. The predominance of men in senior positions may contribute to an <a href="https://fic.tufts.edu/wp-content/uploads/SAAW-report_5-23.pdf">organisational culture</a> and environment that are conducive to the <a href="https://www.reuters.com/article/us-un-sexualharrassment-idUSKCN1PA08E">harassment</a> and the assault of women. </p>
<p>Hiring more women to work at every level of humanitarian response would better reflect the composition of those in need of aid. It <a href="https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-020-00330-9">can improve</a> humanitarian performance, and can shift organisational culture.</p>
<p><strong>Humanitarian actors must partner with and support local women’s organisations.</strong></p>
<p>Local women’s organisations bring cultural and historical knowledge and have credibility within communities. They can help to lead a more effective and accountable response. They can also be powerful allies, potentially vetting and screening local staff. They can promote participation of local women and ensure that vulnerable women know about the policies of international organisations, including where and how to report.</p>
<p><strong>Sexual exploitation and abuse prevention and response specialists must be involved in the design and implementation of emergency responses.</strong></p>
<p>In responses to acute crises and deadly outbreaks, the prevention of sexual exploitation and abuse, and response to accusations, must be taken seriously and planned for. </p>
<p>The independent commission report noted failures to take appropriate staff vetting and training measures. The WHO appointed a few sexual exploitation and abuse focal points but it is not clear what expertise or mandate they had to act. </p>
<p>An important issue like sexual exploitation and abuse should not be relegated to a focal point. Particularly if it’s delegated to an individual who has other responsibilities and may lack knowledge or power to act. Doing so seems like a box-ticking exercise and signals a lack of prioritisation for the organisation. </p>
<p>Organisations should hire teams of sexual exploitation and abuse experts for all operations, routinely subject their programmes to review by independent experts, and learn from these evaluations.</p>
<p>Sexual exploitation and abuse requires an active rather than passive response. The WHO should respond to reports of abuse and exploitation as it does to reports of cases of infectious diseases like Ebola: with swift and thorough expert investigation rather than bureaucratic delay and inaction. </p>
<p>All humanitarian organisations should proactively examine their work to prevent and respond to these situations and focus on following best practices. Now is the time to make the rhetoric of zero tolerance a reality.</p><img src="https://counter.theconversation.com/content/169223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chen Reis was employed by WHO from 2004-2011 and had done some consulting for the WHO since. </span></em></p>Sexual exploitation and abuse requires an active rather than passive response.Chen Reis, Associate Clinical Professor and Director, Humanitarian Assistance Program, University of DenverLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1685132021-09-28T13:43:49Z2021-09-28T13:43:49ZMarburg en Guinée : la valeur des leçons tirées de la gestion d'autres épidémies de fièvre hémorragique<figure><img src="https://images.theconversation.com/files/422621/original/file-20210922-17-13ry3dh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C926%2C601&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Une photo, prise en août 2015, de gants et de bottes désinfectés dans un centre de traitement d'Ébola à Conakry, en Guinée ; des leçons sont tirées pour gérer le virus de Marburg.</span> <span class="attribution"><span class="source">Cellou Binani/AFP via Getty Images</span></span></figcaption></figure><p>Alors que la pandémie de COVID-19 fait rage en Afrique et que la campagne de vaccination est insuffisante, la fièvre hémorragique virale a refait surface. Cette maladie vient s'ajouter aux problèmes de santé publique constatés sur ce continent, où les ressources allouées à la lutte contre les maladies zoonotiques émergentes et ré-émergentes à tendance épidémique restent limitées.</p>
<p>Au cours de la première semaine d'août 2021, un cas de <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">maladie à virus de Marburg</a> a été dépisté dans le sud-ouest de la Guinée. C'est dans cette même région que la fin de la récente flambée d'Ebola a été <a href="https://www.afro.who.int/news/ebola-outbreak-guinea-declared-over">annoncée</a> quelques semaines avant la détection du virus de Margburg.</p>
<p>À ce jour, 14 foyers de la maladie à virus de Marburg ont été signalés depuis 1967 et ont été principalement enregistrés en <a href="https://www.who.int/emergencies/disease-outbreak-news/item/25-october-2017-marburg-uganda-en">Afrique subsaharienne</a>. Le cas le plus récent en Guinée est aussi le premier <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">enregistré</a> en Afrique de l'Ouest. Toutefois, il a été établi que le virus circule dans des pays où aucun cas de maladie du virus de Marburg n'a été diagnostiqué à ce jour, à savoir notamment <a href="https://pubmed.ncbi.nlm.nih.gov/28710694/">le Gabon, la Zambie et la Sierra Leone</a>. </p>
<p>La première épidémie reconnue de la maladie de Marburg en Afrique a été signalée <a href="https://www.jstor.org/stable/20407721">en 1975 en Afrique du Sud</a> ; il s'agissait d'un cas importé du Zimbabwe. Des cas importés d'Ouganda ont été signalés en 2008 aux États-Unis et aux Pays-Bas et une infection en laboratoire a été diagnostiquée en Russie en 2004. L'épidémie la plus importante et la plus meurtrière à ce jour est survenue en Angola en 2004-2005.</p>
<p>Les flambées récurrentes de fièvres hémorragiques virales sont un lourd fardeau pour des pays comme la Guinée, où les systèmes de soins de santé sont déjà en péril.</p>
<p>Heureusement de nombreux pays africains ont une grande expérience en matière de gestion des épidémies de fièvres hémorragiques virales. Les autorités sanitaires guinéennes ont pu réagir rapidement et mettre en œuvre les mesures <a href="https://reliefweb.int/report/guinea/defeating-ebola-guinea-through-better-experience">prises lors de l'épidémie d'Ébola</a> pour endiguer la propagation de Marburg. Ces mesures comprenaient le déploiement rapide d'équipes multidisciplinaires, le diagnostic, la recherche des contacts, l'isolement et le traitement des patients. </p>
<p>L'existence de centres de traitement a grandement facilité le traitement rapide des cas suspects et confirmés. De même, l'expertise a amélioré la prise en charge des patients.</p>
<h2>Le virus de Marburg</h2>
<p>Il appartient à la même famille que les virus Ébola. Il provoque des maladies sporadiques, mais souvent mortelles chez les humains et les primates non humains. Des études indiquent que la chauve-souris Roussette égyptienne, <em>Rousettus aegyptiacus (famille des Pteropodidae)</em>, est le principal hôte réservoir. Le contact de l'homme avec les habitats de repos de ces animaux, dont les grottes, ainsi que les activités minières peuvent entrainer la transmission du virus de Marburg à l'homme.</p>
<p>Ce virus se transmet par contact direct avec le sang, les sécrétions corporelles et/ou les tissus de personnes ou d'animaux sauvages infectés, par exemple des singes et des chauves-souris. Il peut également se transmettre par contact avec des surfaces et des matières comme la literie ou les vêtements contaminés par ces fluides. </p>
<p>La période d'incubation varie de 2 à 21 jours. Les symptômes sont, entre autres, la fièvre, des malaises, des courbatures, des nausées, des vomissements, la diarrhée et des hémorragies internes (saignements). </p>
<p>Il peut être difficile de faire la distinction entre le virus de Marburg et d'autres maladies tropicales fébriles courantes, en raison des similitudes qu'ils partagent quant à leur présentation clinique. Selon des cas confirmés en laboratoire, l'infection par le virus de Marburg peut entraîner la mort de 23 à 90 % des patients.</p>
<p>Il n'existe pas de traitement antiviral spécifique ni de vaccin préventif. Les soins de soutien notamment les perfusions, le renouvellement des électrolytes, le supplément d'oxygène (oxygénothérapie) le renouvellement du sang et des produits sanguins, peuvent considérablement améliorer le tableau clinique.</p>
<p>Le virus de Marburg peut se propager facilement, si l’on ne prend pas des mesures préventives appropriées, comme la protection personnelle, les soins en isolement, la gestion sûre des funérailles, la recherche de cas, la recherche de contacts, l'isolement et le traitement du patient.</p>
<p>Le virus est susceptible de provoquer des épidémies redoutables aux conséquences graves pour la santé publique.</p>
<h2>Les étapes importantes</h2>
<p>La région de Guinée où le cas de maladie à virus de Marburg a été détecté, partage la même frontière avec la Sierra Leone et le Liberia. Les déplacements de personnes au niveau interne et transfrontalier peuvent entraîner une propagation potentielle, c'est pourquoi les étapes suivantes sont essentielles :</p>
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<li><p>Déploiement des équipes d'intervention bien préparées <a href="https://www.who.int/publications/i/item/ebola-and-marburg-virus-disease-epidemics-preparedness-alert-control-and-evaluation">au niveau national et du district</a>.</p></li>
<li><p>Surveillance et coordination des efforts menés à l’intérieur des pays et entre eux.</p></li>
<li><p>Surveillance des points d'entrée.</p></li>
<li><p>Recherche de contacts et recherche active de cas dans les établissements de santé et au niveau communautaire.</p></li>
<li><p>Ouverture d’enquêtes afin d’identifier la source de l'infection.</p></li>
<li><p>Réalisation de tests en laboratoire sans délai.</p></li>
<li><p>Mobilisation de la communauté. </p></li>
</ul>
<p>Il est primordial, par ailleurs, d'éduquer le public et de sensibiliser la communauté aux facteurs de risque et aux mesures de protection que les individus peuvent prendre pour limiter les risques d’exposition à la maladie, notamment :</p>
<ul>
<li><p>éviter les contacts physiques étroits avec une personne soupçonnée d’avoir contracté le virus ;</p></li>
<li><p>transférer tout cas suspect dans un établissement de santé pour traitement et isolement ;</p></li>
<li><p>enterrer sur le champ et avec toutes les mesures de sécurité des personnes décédées du virus ;</p></li>
<li><p>inciter les travailleurs de la santé qui s'occupent des cas à virus Marburg suspects ou confirmés à prendre les précautions de prévention et de lutte contre les infection. Cela permet d'éviter toute exposition au sang et/ou aux fluides corporels, ainsi que tout contact avec un éventuel foyer de contamination</p></li>
<li><p>manipuler les animaux sauvages avec des gants et des vêtements de protection appropriés afin de réduire le risque de propagation ;</p></li>
<li><p>Bien cuire les produits d'origine animale (sang et viande) avant de les consommer, et éviter la consommation de viande crue.</p></li>
</ul>
<p>La participation de la communauté est essentielle pour riposter et une lutter efficacement contre à la pandémie. Cela doit se faire avec le soutien des systèmes de soins de santé primaires, de manière à susciter une participation et un engagement plus actifs.</p>
<h2>Ce qu’il faut corriger</h2>
<p>Un certain nombre de facteurs entravent la recherche, la gestion et le contrôle des zoonoses en Afrique, à savoir :</p>
<ul>
<li><p>l’insuffisance et le manque de coordination des programmes de surveillance et de recherche ;</p></li>
<li><p>les capacités régionales trop limitées pour mettre au point de nouveaux tests de diagnostic améliorés ;</p></li>
<li><p>le manque d'installations de confinement à haute sécurité;</p></li>
<li><p>le manque de biobanques stratégiques pour le stockage à long terme et sécurisé des matériaux cliniques de référence, des souches et de biodiversité des agents pathogènes;</p></li>
<li><p>l’absence de programmes régionaux d'assurance qualité externe pour les agents pathogènes viraux et bactériens endémiques dangereux.</p></li>
</ul>
<p>** Il est essentiel de mettre en place un système rationalisé, bien financé et efficace de signalement en temps opportun et de suveillance des maladies pour détecter les menaces d'épidémies potentielles. Afin d’accroître l'efficacité d'une intervention rapide, chaque nation doit renforcer ses propres capacités en matière de reconnaissance des maladies et de compétences de laboratoire. </p>
<p>Il nous faut également trouver des approches innovantes axées sur l’Afrique pour faire le grand bond en avant nécessaire au développement des capacités scientifiques pour la surveillance et la lutte contre les maladies infectieuses.</p>
<p>Les initiatives mondiales visant à améliorer la préparation en prévision des situations d'urgence et les systèmes de santé sont aussi importantes. Cependant, il est nécessaire d’effectuer un travail considérable au niveau supérieur de la gouvernance nationale pour renforcer la résilience et réduire la vulnérabilité.</p><img src="https://counter.theconversation.com/content/168513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Groome reçoit des fonds de South African Medical Research Council et de la Fondation Bill-et-Melinda Gates.</span></em></p><p class="fine-print"><em><span>Le professeur Janusz T. Paweska a reçu des financements du CDC Global Disease Detection Program pour des études sur la présence d'agents pathogènes zoonotiques dans les populations de chauves-souris d'Afrique du Sud; de la Poliomyelitis Research Foundation pour des infections expérimentales de chauves-souris par les virus Ebola et Marburg et pour l'étude de la transmission du virus à Marburg par les ectoparasites associés aux chauves-souris; et du South African Medical Research Council pour étudier l'épidémiologie moléculaire de la maladie à virus Ebola en Afrique de l'Ouest et la mise au point de capacités de diagnostic.
</span></em></p>De nombreux pays africains ont acquis beaucoup d'xpériences en matière de gestion de épidémies de fièvres hémorragiques virales qu'ils peuvent appliquer à celle du virus à Marburg.Michelle J. Groome, Head of the Division of Public Health Surveillance and Response, National Institute for Communicable DiseasesJanusz Paweska, Head of the Center for Emerging and Zoonotic Diseases, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666942021-08-30T15:30:30Z2021-08-30T15:30:30ZThe first human case of Marburg virus in West Africa is no surprise: here’s why<figure><img src="https://images.theconversation.com/files/418247/original/file-20210827-23-1ekjv48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">GPS devices on 20 bats in a Ugandan cave in 2018 as part of a research project to determine flight patterns and how they transmit Marburg virus to humans. </span> <span class="attribution"><span class="source">Bonnie Jo Mount/The Washington Post via Getty Images</span></span></figcaption></figure><p>The first case of fatal Marburg virus disease was identified in Guinea, West Africa on <a href="https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea">9 August 2021</a>. Marburg is a highly infectious zoonotic haemorrhagic fever transmitted to people from fruit bats, specifically the Egyptian Rousette bat (<em>Rousettus aegyptiacus</em>). It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.</p>
<p>No cases have previously been reported in West Africa. </p>
<p>Marburg virus is part of the same family as the Ebola virus. Guinea’s detection comes less than two months after it <a href="https://africacdc.org/news-item/republic-of-guinea-declared-end-of-second-ebola-virus-disease-outbreak/">declared</a> an end to an Ebola outbreak that erupted earlier this year. It is also the same region where cases of the 2021 Ebola outbreak in Guinea and the 2014–2016 West Africa outbreak were <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">initially detected</a>. Zoonotic diseases will continue to emerge in areas where the reservoir host species occurs and opportunities for contact between humans and wildlife arise. </p>
<p>Marburg disease was first reported <a href="https://doi.org/10.1111/jzo.12769">in 1967</a> in laboratory workers in Germany and Yugoslavia (now Serbia), transmitted from green monkeys (<em>Chlorocebus sabaeus</em>) imported from Uganda to Europe. </p>
<p>Since then, Marburg virus has been <a href="https://doi.org/10.1111/jzo.12769">reported</a> in various parts of Africa in bats. Human disease has been <a href="https://doi.org/10.1111/jzo.12769">reported</a> from Angola, the Democratic Republic of Congo (DRC), Kenya, Uganda and an imported case in South Africa. </p>
<p>The most significant human outbreaks were in the <a href="https://www.mdpi.com/1999-4915/4/10/1878">DRC in 1998–2000 and Angola in 2004–2005</a> with 128 and 227 human fatalities. Case fatality rates varied from 24% to 88% in past outbreaks, depending on virus strain and case management. </p>
<p>The latest detection in West Africa expands our knowledge of the incidence of spillover and human diseases to a new geographical area.</p>
<h2>What does this mean?</h2>
<p>For more than two decades after the first detection, scientists didn’t know how the green monkeys from Uganda had got the disease. The host species – where the virus lives in nature – and epidemiology – how it spreads – weren’t understood. It was only in 1999 that Marburg virus was detected in bats for the first time, including the Egyptian Rousette bat in the DRC. This indicated that the host of the virus might be bats. The virus was detected and isolated from Egyptian Rousette bats in East Africa and South Africa in the following years, expanding the geographical range. </p>
<p>This bat is cave-dwelling and widespread throughout Africa, including West Africa.</p>
<p>The Egyptian Rousette bat has been confirmed as a reservoir host species of Marburg virus. This was done through surveillance and follow-up experimental infections in a laboratory to investigate disease development in a controlled environment. When these bats are infected they do not show signs of disease but can transmit it to humans and other animals, where it is sometimes fatal. </p>
<p>Specific high-risk infection periods have been identified in bat populations, and birthing periods during the summer are reported to be a driver. These pulses coincided with the timing of human infections <a href="https://doi.org/10.1371/journal.ppat.1002877.">in Uganda</a>. The Egyptian Rousette bat lives in caves or mines, and outbreaks have been <a href="https://doi.org/10.1371/journal.ppat.1002877">linked</a> to gold mining activities and entering caves with potential contact with bat faecal excretions or aerosols.</p>
<p>The geographical range where Marburg virus has been detected in bats is more widespread than recorded <a href="https://doi.org/10.1111/jzo.12769">human outbreaks</a> and they coincide with the presence of the Egyptian Rousette fruit bat. However, surveillance has been sporadic and hasn’t covered all geographical areas in the past. Studies in West Africa have been very limited. Wildlife surveillance is severely lacking on several levels including collection of samples. Diagnostic capacity to test for these types of viruses is also lacking. The same is true for detecting disease in humans especially when only a few cases occur and in very remote areas.</p>
<p>From our knowledge of the epidemiology of the virus, it will be present wherever this bat species occurs. Environmental and man-made changes act as a significant <a href="https://doi.org/10.1038/nrmicro.2017.45">contributor</a> to disease emergence. These include changes in land use, human population growth and increased mobility across landscapes, changes in human socioeconomic behaviour or social structure, increased trade, forest fires, extreme weather events, wars, and breakdown in public health infrastructure, to name a few. These activities also result in increased contact with wildlife such as bats, ultimately leading to a higher risk of spillover. The Egyptian Rousette bat will also use abandoned mines as roosting sites and this may change their distribution. </p>
<p>As additional opportunities arise for spillover, it’s probable that more of the bat-borne viral diversity could spill over in the future. This is also true for Marburg virus. More opportunities for contact between bats and humans will certainly lead to an increase in human infections.</p>
<p>This again highlights the importance of surveillance, quickly detecting these spillover events to prevent further human transmission, and building the in-country capacity to make the diagnosis quickly and efficiently.</p><img src="https://counter.theconversation.com/content/166694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wanda Markotter receives funding from the National Research Foundation and Defense Threat Reduction Agency, USA . </span></em></p>The Marburg virus will be present wherever the Egyptian Rousette bat occurs.Wanda Markotter, Professor/Director Centre for Viral Zoonoses/ DST-NRF South African Research Chair, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.