Uganda Tests Preparedness for Ebola as DRC Documents 26 Deaths in 1 Day

May marks the 10^th consecutive month of the Ebola outbreak in the North Kivu and Ituri Provinces of the Democratic Republic of the Congo. The outbreak has documented more than 1000 confirmed cases since August and has seen several violent incidents, including the death of a physician from Cameroon who was assisting in the outbreak response.

On April 29, 2019, a record of 26 new confirmed cases and 26 new confirmed deaths were documented in the outbreak.

Despite the severity of the outbreak and the threat of violence, the World Health Organization (WHO) has decided against declaring a Public Health Emergency of International Concern on 2 occasions, in October 2018 and earlier in April 2019. This decision is reportedly based on the fact that Ebola has not spread outside of the 2 provinces into other parts of the country or to bordering nations.

Although the outbreak has remained contained thus far, health officials in neighboring Uganda remain on high alert for a potential transmission and recently conducted a simulation exercise in 2 districts to evaluate preparedness and identify areas of weakness that could use improvement.

The simulation exercise was conducted in the Wakiso and Kasese districts and set out to evaluate Ebola outbreak readiness on local, district, and national levels. According to a summary of the simulation, the National Task Force demonstrated that they were aware of the proper protocols and could easily mobilize different elements of outbreak response in a short amount of time.

For the simulation, health workers established primary and secondary screening checkpoints at points of entry in the provinces, established an Ebola treatment unit in Bwera, and formed village health teams that were tasked with identifying suspected cases and disseminating educational information. Health workers were also tasked with conducting safe transportations of Ebola “patients” via ambulance.

During the simulation, health officials observed productive communication between the Public Health Emergency Operating Center and designated emergency sites. Check-points at points of entries were observed to be well-conducted, with health officials noting that adequate materials including thermometers, protective equipment, hand washing facilities, and chlorine were available, reinforcing that the nation has been diligent in preparing in case of an outbreak.

It was observed that the treatment unit was prepared and well-maintained with proper materials and staff were well-trained in Ebola management. The village health teams were also observed as being prepared and competent in identifying suspected cases while disseminating information. Health officials with WHO Uganda reported that the simulation “found heightened community risk perception pointing to the good work done on community engagement and risk communication.

The simulation also exposed challenges that could inhibit critical elements of the response. Although the emergency operations center had good communication with emergency sites, there were roadblocks to communication with health workers at the health centers, points of entry and, in particular, the Ebola treatment units at 2 hospitals and the international airport. If this situation occurred during a real outbreak, it would lead to delayed identification of patients along with slow transfers and management of suspected cases.

Additional challenges included gaps in contact tracing and security at the treatment units, inconsistent travel screenings, inadequacies in use of personal protective equipment, and other elements included in infection prevention protocols. The exercise also identified a need for more defined roles for health workers, including the laboratory teams who test samples of blood for the virus.

“We have to build a sustainable system not only for EVD but also for other health problems. The more we do this the better we shall get at it. WHO is there to support the process,” Yonas Tegegn Woldemariam, MD, the WHO Representative in Uganda, said in the report.

Uganda is not the only area where Ebola preparedness drills are being conducted. New York City Health released a statement on April 30, detailing an emergency exercise conducted by NYC Health along with New Jersey health departments to safely transport a simulated Ebola patient.

The exercise is the first of its kind between the 2 states and involved more than 70 participants from health care facilities and state and local agencies. For the exercise, the “patient” was transported from Robert Wood Johnson University Hospital in New Brunswick, New Jersey, to the Regional Ebola and Other Special Pathogen Treatment Center at NYC Health + Hospitals / Bellevue in New York City.

“This training exercise further builds upon New York State’s 2014 Ebola Preparedness Plan that designated Bellevue Hospital as one of ten hospitals statewide to manage Ebola patients,” New York State Department of Health Commissioner Howard Zucker, MD, said in a statement. “In our interconnected world, we must be prepared to care for people from around the world and when global health concerns arrive here.”

A recent study found that frontline hospitals in Arizona were relatively unaware of proper protocol for handling patients with high-consequence pathogens such as Ebola. The investigators reported that 40% of the surveyed individuals could not describe a proper communication strategy, and only 20% thought to call the infection prevention and control team.

As the DRC Ebola outbreak continues to grow, 1 thing is clear—more preparation is needed in many health systems around the globe.

For the most recent case counts in the Ebola outbreak in the DRC, check out the Contagion® Outbreak Monitor.