Managing Two Viruses at the Same Time

Dear Colleagues,   The Ebola virus disease epidemic in West Africa appears to have begun in December 2013. The index case is believed to have been a two-year old boy in Guinea. He first, then his mother, sister, and grandmother all fell ill with similar symptoms and died. Retrospective case-finding by WHO identified the child as West Africa’s first case of this EVD epidemic. The disease spread to Liberia and Sierra Leone, affected Mali, Nigeria, Senegal, Spain, United States, United Kingdom, and Italy, infected over 28,000 people, and led to over 11,000 deaths. Just over two years passed before the West African region was declared Ebola-free on January 14, 2016. ProMED was amongst the first to report on the undiagnosed hemorrhagic fever in Guinea that foretold the Ebola outbreak. The ability to quickly detect and verify unusual health events around the world and share that information with 90,000 subscribers in over 200 countries is what makes ProMED so valuable to researchers, physicians, journalists, government officials, and you. ProMED published over 600 reports on EVD during the West Africa epidemic – and another 452 since it ended. Nobody else provides this depth of information. Please join your colleagues in supporting free information – please donate to ProMED today. Given all that was learned about preventing Ebola virus transmission and caring for people with the disease, given a promising vaccine and new treatment protocols, one would have hoped that the Ebola outbreak recognized in early August in the Democratic Republic of Congo would have been rapidly contained. But North Kivu province, the epicenter of the outbreak, is also the epicenter of violence caused by nongovernmental militias. The political instability that comes with insecurity compounded by large populations of refugees and internally displaced people has contributed to making the current outbreak an intractable public health challenge.   War has always been associated with disease. During the American civil war, two-thirds of soldiers’ deaths were caused by typhoid fever, smallpox, measles, dysentery, pneumonia, malaria, and tuberculosis--half by dysentery alone. While the situation in the DRC is not a declared war, North Kivu is essentially a war zone. Recurrent attacks on the city of Beni, the focus of the outbreak and the response operation’s headquarters, have hindered efforts to contain the virus. Healthcare workers face the stress of dealing with a deadly disease and the stress of working in a high-risk area where gunfire is heard nightly, kidnapping for ransom is a real danger, and mobile medical teams and burial crews have been attacked. After each major spate of violence in Beni, medical operations have been halted for days, interrupting the vaccination campaign and contact-tracing measures vital to epidemic control. Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, refers to managing two viruses at the same time, “The insecurity is a virus. And there is another virus, Ebola.”   As this letter is written, 440 cases have been confirmed and 48 are considered probable; there have been 255 deaths. This outbreak has now become the second deadliest EVD outbreak ever. New suspected cases, confirmations, and deaths are reported daily and the WHO’s emergency response chief, Dr. Peter Salama, expects the outbreak to last another six months. No matter how long the outbreak in the DRC lasts – or where it spreads – the international infectious disease community will need accurate, unbiased, timely information to formulate plans, make decisions, and allocate resources. As scientists, clinicians, and health care professionals, it is incumbent upon us to make certain that the public is informed and that public health decisions are evidence-based decisions, not poll-driven political calculations. Connecting us in an international infectious disease community, ProMED has for over twenty years made freely available the news that raises questions and the data on which the answers are built. But for ProMED to remain an active force and continue to provide validated, credible information every day, we need your help. Please give generously to keep ProMED unfettered and free. Your support now will help ensure that ProMED continues to meet the information needs of those who study infectious diseases, treat infected patients, protect the public health, and plan responses to future disease outbreaks. Please join me and your colleagues worldwide in ensuring ProMED is there providing the news and commentary.  Best regards,   Larry Madoff, MD Editor, ProMED 9 BABCOCK STREET, UNIT 3 BROOKLINE, MA 02446 USA 617.277.0551 ISID’s ability to advance its mission is contingent upon the support of individuals and institutions who value and benefit from our work