WHO conducting Emergency Meeting for EBOLA outbreak-Cases spreading to. MORE cities Page 8

Yes, digging up Ebola corpses is never good. It is a truly unprecedented mess out there. As those fleeing, which sounds like almost all from the epicenter of the outbreak, we will begin to see a rapid geographical spread i the next one to two weeks. Many will visit family in large, impoverished cities, some may travel to neighboring nations, while others may travel internationally. We have never seen anything like this....EVER.

I began warning weeks ago, but most considered it to be the same as every outbreak of Ebola.

With incubation periods of 7-14 days, and up to 40 days or more in the extreme, people will travel, unknowingly carrying the virus, just not yet having symptoms. It is essentially the perfect storm for regional/international transmission.

The good thing, FOR NOW, is that it is not the most effective spreader. As viruses do, they constantly attempt to change, in order to defeat their hosts. We know very little still, about its ability to mutate, especially outside of the typical regions in Africa. Also, there are now 6 strAins of Ebola, that we know of. The newest variety, we know nearly nothing about, other than it is carried by bats.

Point is, what was Ebola yesterday could mutate to become more infectious. Also, coinfection, with a respiratory virus, could potentially allow for gene swapping, making Ebola cause more symptoms of coughing and sneezing. Also, it's ability to become more partial to receptors in the lungs presents another possibility. The more cases we have, the more mutations can occur.

Via CIDRAP, Lisa Schnirring writes: Ebola cases in Beni top 100 as 6 more cases reported. Excerpt:

Medical teams have confirmed Ebola in six more people in the Democratic Republic of the Congo (DRC) outbreak, all from the hot spot in Beni where violence over the weekend has slowed vaccination activities, the country's health ministry said today.

Also, the World Health Organization (WHO) detailed renewed concerns about fresh violence undermining the response and the increasing numbers of Ebola infections in children.

Getting sick people into isolation and treatment is a key part of the outbreak response, and continued reports of community deaths are a sign that responders are having a tough time identifying all active transmission chains.
The 6 new cases boost the outbreak total to 244 cases, including 209 confirmed and 35 probable cases. The new deaths bring the fatality total to 155.


In its daily update, the health ministry said cases in Beni health zone now stand at 102.

As feared following another round of rebel violence over the weekend, immunization activities in Beni are slowing owing to insecurity in some parts of the city, according to the health ministry. So far, 20,939 people have been vaccinated, including 9,853 in Beni.

Comment

(This is exactly what I mean, and have been trying to say.... the entire Epidemiologic case work is being made nearly impossible. They will eventually have to spread out further and further. In either remote villages, or dense cities. Finding, and managing those cases, and maintaining contact will likely be the biggest difficulty they have ever faced.)

Here's above link

[link to www.cidrap.umn.edu]

This article speaks exactly what I am trying to say to those who may think it's another media blowup..Whole section deserves bold text.

[link to boingboing.net (secure)]

Ebola outbreak in Congo: things are getting worse

The World Health Organization hasn't classified the outbreak as a world health emergency, yet. But the conditions are perfect for the current Ebola flareup to become an absolute containment clusterfuck. War keeps populations moving as they work to avoid the violence. Displaced people mingle in areas where they may not have in the past – from population centers to refugee camps: anywhere they can shelter from the horrors that drove them from their homes. Given that an individual can carry Ebola for weeks without knowing or showing any symptoms, it's already difficult to know who to segregate from the population without having the potentially infected roaming around. Add to this the threat of violence at every turn and you've got the makings of a disaster.

[link to www.statnews.com (secure)]

Since the beginning of October, a period during which cases have surged, a growing proportion of new cases in Beni have come from outside the contact lists and can’t be fitted into the chain of transmission, said Dr. Peter Salama, the WHO’s deputy director-general of emergency preparedness and response.

The contract tracing performance is measured in percentages — the proportion of known contacts that are followed up daily. Ideally that figure should be in the mid-to-high 90s. And it has generally been that high elsewhere in North Kivu, said Salama.

But in Beni, it has been highly variable, he said, adding that after episodes of violence, the contact tracing performance at Beni has dipped to 30 percent or 40 percent.

The longer contact tracing flags, the more likely it is that the percentage of people being missed grows in an invisible fashion.

Rimoin, who has a long-standing research project in DRC, knows the difficulties the responders face. “The area in which this outbreak has emerged is a very difficult and complex place to have to do this work — to do any work. But to have to combat Ebola in this area is mindbogglingly difficult,” she said.

While 300,000 doses seems like a substantial supply, Salama said he worried using the vaccine geographically could draw down the stockpile quickly. He noted the WHO has to also consider what might happen if this outbreak spreads into neighboring Uganda — which is expected to soon start vaccinating health care workers in locations where cross-border cases might turn up — or Rwanda or South Sudan.

Salama also said he is concerned a geographic approach to vaccination might not solve the underlying problem — the fact that some people in the outbreak area continue to resist all of the control measures the responders use.

“If your high-risk contacts are actively avoiding follow-up or vaccination or care, they’re going to avoid vaccination or geographic targeting strategy presumably as well,” he said. “So you might end up thinking you’ve got great coverage geographically, but you’ve missed the same high-risk contacts that we’re unable to follow up on now. So it will have very limited impact in that sense.”

I guess it is late, but here are some tidbits of info about studies of bats, and what they carry. Keep in mind, we know several deadly pathogens this far from bats, spanning from West Africa to South East Asia, and between. What is striking, is that we may know less about what they do carry, and really just the tip of the iceberg. This is seen often, as the several virus subtypes often are found to have new cousins we weren't even aware of.

Of the bat viruses, the most dangerous are likely novel influenza strains, similar to Avian influenza. But even more so, the Paramyxoviruses which cause the Nipah virus. The virus from the movie contagion was modeled off of a variant of this virus. It has only been known of since the late 90's and outbreaks have occurred in very rural areas. This virus spreads efficiently h2h as evidence in the Bangladesh strain, and is extremely deadly with CFR often at 70% and above. It causes, coughing, sneezing, and other respiratory symptoms, thus aiding its spread, through droplets, mist, and likely fomites.

This is the virus also studied in the Clade X exercises from John Hopkins. The exercises expect a parainfluenza Nipah virus that kills 150-900 billion depending on which scenario. A ton of research and funding, spanning two years has gone into this "simulation" Even so far as to have mock news clips on youtube, about the current state of the world. I can link this too later, as it is one study, of a very limited few who are looking at all the downstream repercussions of such an outbreak. These are things many completely forget about it disregard... Anyways here is the link I promised.


[link to nationalzoo.si.edu (secure)]

Linno Cave is home to at least four bat species. So far, the researchers have successfully caught and taken samples from wrinkle-lipped bats and cave nectar bats. The bats are given sugar water before being released to ensure they have the energy to continue their flight — just like a person might receive a sugary juice after a blood drive.

Scientists at laboratories in Yangon analyze the samples from each research site for five types of viral families:

Coronaviruses

Examples: Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS)
These viruses are common in many species, including camels and bats. Though most coronaviruses are species-specific, some have spread to humans.

Filoviruses

Examples: Ebola
In primates, including humans, filoviruses can cause hemorrhagic fever — which damages the vascular system and impacts the body's ability to regulate itself. This viral family has also been detected in pigs and bats. Bats are believed to be the source of recent Ebola outbreaks in Africa.

Paramyxoviruses

Examples: Nipah virus, Hendra virus, Measles, Mumps, Canine distemper

The flying fox is a natural carrier for both Hendra virus and Nipah Virus. Hendra can cause respiratory and neurologic diseases in horses and humans, while Nipah has spread to pigs and humans, causing encephalitis (inflammation of the brain) and respiratory illness.

Influenza viruses

Examples: Bird flu (e.g., H5N1, H7N9), Swine flu (e.g., H1N1)
Influenza viruses impact many species, including (but not limited to) ducks, chickens, pigs, whales, horses, seals and humans. The flu can spread from person to person, and is most common in the U.S. during the fall and winter.

Flaviviruses

Examples: Zika virus, West Nile virus
These viruses are typically spread by ticks, mosquitoes and other arthropods.
Scientists sequence the viruses they detect in animals to determine their pathogenicity, or ability to cause disease, in humans. Any viruses detected in samples from humans are analyzed for pandemic potential. If a virus is considered a concern, the researchers work with Myanmar’s government to determine the immediacy of the issue and whether a response is necessary.

The researchers have already identified two new coronaviruses in saliva and fecal samples from insect-eating bats. One of these viruses had never been detected in the world, and the second had only been identified in Thailand’s bats. While these new viruses belong to the same family as SARS and MERS, there is no evidence that they pose a threat to people at this time.

About Bats...even more. Hopefully someone out there appreciate the further research into the current outbreak, and some science where it all seems to start.

[link to www.sciencemag.org]

Bats really do harbor more dangerous viruses than other species

That debate may finally be over. A broad look at all viruses known to infect mammals suggests that bats are, indeed, more likely to carry unknown pathogens that can wreak havoc on humans. Surprisingly, the study comes from researchers who until now were bat doubters. “As a scientist, you accept the results of your own study—even if they prove you wrong!” says disease ecologist Peter Daszak of the EcoHealth Alliance in New York City, a senior author on the new study.

Daszak's group started out trying to answer a broader question: Where should scientists concentrate efforts to find as-yet-unknown viruses threatening humanity? Most emerging infectious diseases are zoonoses, diseases that originate in animals, and some may have the potential to trigger massive epidemics. But there are thousands of species of mammals, potentially carrying hundreds of thousands of viruses—so where do you start?

In their next step, the scientists looked only at the 188 known zoonotic viruses, agents that have been found in humans and at least one other mammal. Even after accounting for factors that would increase zoonotic virus load—how closely the animal is related to humans or how much its habitat overlaps with cities, for example—bats host a significantly higher proportion of zoonoses than other mammals, the researchers report today in Nature. They estimate that there are about 17 zoonoses yet to be discovered in every bat species versus about 10 for rodent and primate species.

But that's no reason to fear or fight them, he adds. Bats have many useful roles, from pollinating flowers to controlling insects. And virus outbreaks are not inevitable as long as humans keep their distance. "These viruses will only emerge in people if we continue encroaching into bat habitat, hunting and eating them, and otherwise making contact with them,” Daszak says.

Just what makes bats special is still unclear; there are many competing hypotheses, from a primitive immune system to echolocation creating droplet clouds that help spread viruses. The next debate is about to take off.

[link to news.un.org (secure)]

The United Nations Security Council has voiced “serious concern” over the impact of deteriorating security situation in the Democratic Republic of the Congo (DRC) on the response to the deadly Ebola outbreak and fears that the virus could spread further into the country and the wider region.

Unanimously adopting resolution 2439 (2018), the 15-member Council “demanded” that all armed groups in the region respect international law and ensure full, safe, immediate and unhindered access for humanitarian and medical personnel, and their equipment, transport and supplies to the affected areas.

Humanitarian response teams and hospitals providing life-saving assistance and relief to those in need “must be respected and protected, and that they must not be a target,” said the Security Council in the resolution.

Last update from MSG

• 65 suspected cases under investigation.
• 2 new cases confirmed in Beni.
• 1 new confirmed case death in Beni.
• 1 healed in Beni.
• 5.483 contacts to follow to date.

Still increasing, but what we do not know is the spread to other areas with less monitoring or testing abilities.

Or worse yet, cases occurring, farther from the outbreak, where they may not be having similar surveillance. Also, countries in the region, seriously lack transparent info.

[link to www.washingtonpost.com (secure)]

CDC director warns that Congo’s Ebola outbreak may not be containable

Centers for Disease Control and Prevention Director Robert Redfield said Monday that the Ebola outbreak in conflict-ridden Congo has become so serious that international public health experts need to consider the possibility that it cannot be brought under control and instead will become entrenched.

If that happened, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak led to the persistent presence of the disease. In all previous outbreaks, most of which took place in remote areas, the disease was contained before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.

If Ebola becomes endemic in substantial areas of North Kivu province, in northeastern Congo, “this will mean that we’ve lost the ability to trace contacts, stop transmission chains and contain the outbreak,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, which hosted the briefing on Capitol Hill that featured the Ebola discussion with Redfield.

In that scenario, there would be a sustained and unpredictable spread of the deadly virus, with major implications for travel and trade, he said, noting that there are 6 million people in North Kivu. By comparison, the entire population of Liberia, one of the hardest-hit countries during the West Africa Ebola epidemic of 2014-2016, is about 4.8 million.

The outbreak is taking place in a part of Congo that is an active war zone. Dozens of armed militias operate in the area, attacking government outposts and civilians, complicating the work of Ebola response teams and putting their security at risk. Violence has escalated in recent weeks, severely hampering the response. The daily rate of new Ebola cases more than doubled in early October. In addition, there is community resistance and deep mistrust of the government.

Keep in mind the true case count and fatalities are likely WAY higher than the daily reports suggest.

People are fleeing, resisting health care, and violence is obscuring the situation.

Comment from promedmail.org

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The dire prediction by the CDC Director Robert Redfield that the Ebola outbreak may no longer be containable, suggests that WHO should call a PHEIC immediately, which it stepped back from during its last meeting. But it may be too late since new chains of transmission are being missed. Endemic transmission of Ebola virus is not a manageable situation because of the highly infectious nature of the virus and its persistence in the body. A new approach to control will need to be undertaken to cover a much broader group of people than known contacts. - Mod.LK]

This article from ⁦@bylenasun⁩ should not be lost among competing U.S. election headlines. “An estimated 60 to 80 percent of new confirmed cases have no known epidemiological link to prior cases...” Traditional containment approaches don’t apply.
[link to www.washingtonpost.com (secure)]

IMAGE ( [link to pbs.twimg.com (secure)] )

[link to actualite.cd (secure)]

A first confirmed case of Ebola virus disease was recorded in Mutwanga, near the city of Beni in North Kivu province, becoming the twelfth metropolitan area affected by the epidemic, reported Thursday, November 8, the Ministry of Health.
The first confirmed case is a known contact and followed by a confirmed case of Beni, explains in essence the ministry in its statement released Thursday night.
As in many affected localities, this case "refused the vaccination and fled to Mutwanga before the end of its follow-up. The central office of the Mutwanga Health Zone, which had been informed of the presence of a high-risk contact in their territory, found him ill. He finally agreed to be transferred to the CTE of Beni," adds the health authority.