RECOMENDATIONS: Ebola Response Priorities in the Time of Covid-19

Ebola Response Priorities in the Time of Covid-19 | NEJM Perspective from The New England Journal of Medicine — Ebola Response Priorities in the Time of Covid-19 New England Journal of Medicine

On April 10, 2020, a total of 53 days after the last patient with Ebola virus disease (EVD) had been isolated and more than 23 months since the start of the 10th EVD outbreak in the Democratic Republic of Congo (DRC), a new confirmed case was reported in the Beni health zone. This case, and the six that followed, brought the total to 3462 cases — the second-largest Ebola outbreak in history.

Although the outbreak was declared over on June 25, 2020, additional cases attributable to persistently infected survivors may occur. Therefore, surveillance and rapid-response capacity should be maintained, not only for a duration equivalent to two incubation periods (42 days) after the last confirmed case tested negative, but also for at least 90 additional days of enhanced surveillance.

In the 2013–2016 Ebola epidemic in West Africa, there were at least eight flare-ups from persistently infected survivors, which extended the required response for 11 months after the first declaration of Ebola-free status by the Liberian Ministry of Health.¹ During the 10th DRC outbreak, a single relapsed case of EVD resulted in at least 74 additional infections in 13 health areas in six health zones, extending the need for the full response effort by several months.² Missed Ebola cases and reignition of the 10th outbreak, when the impact may be amplified by a lack of attention and resources due to the Covid-19 pandemic and the declaration of the 11th DRC Ebola outbreak in Equateur Province, could be devastating for DRC and neighboring countries.

As ongoing transmission in the 10th outbreak narrowed to two health zones in late February 2020, the Ebola response operation decommissioned 4 of its 10 local coordination units. The responsibility for Ebola activities was transferred to the provincial health authorities without clear operational plans or provision of training, staff, or resources. In addition, the national leadership for the Ebola response was also tasked with overseeing the DRC Covid-19 response, and many Ebola-response staff members were shifted to Covid-19 activities. The loss of technical capacity, resources, and focus puts the quality of ongoing EVD surveillance at risk.

To maintain the ability to rapidly detect and respond to new EVD cases, we recommend that the response partners, including U.S. government agencies, initiate or strengthen the critical strategies discussed below. Where possible, these activities should be broadened to include surveillance and detection of Covid-19 cases and to strengthen provincial capacity for surveillance and infection prevention and control generally. ...

(See link for full list of recomendations.)