Fears over further spread of Ebola as case found in city of one million

Anne Gulland
A health worker takes the temperature of a man entering an Ebola treatment centre - REUTERS

Fears are growing that the Ebola outbreak in the Democratic Republic of Congo could spiral further out of control as a case of the disease has emerged in Goma - a city that is home to around one million people and is a major trade and transport hub.

There have long been fears over the spread of Ebola to the city, the capital of the province where the disease has been raging since August last year.  

There is a real danger the disease could run amok in this densely-packed urban area, as well as make its way across the porous border to nearby Rwanda – despite increased surveillance at crossing points.

The case emerged on the same day that the major partners fighting the  outbreak – including the DRC government, the World Health Organization, the United Nations and UK and US governments – met in Geneva to discuss a “reset” to the response and urge more donors to come forward and help bring the epidemic under control.

So far, there have been nearly 2,500 cases of the disease, including 1,600 deaths. 

The UK has already been one of the most generous donors to the response - giving around £37.7 million in total - and international development secretary Rory Stewart pledged an extra £50 million to fight the disease. The US is the biggest single donor and said it will provide "more in the coming months". 

Mr Stewart paid tribute to the many people doing an "extraordinary job on the ground".

But he added: "There are still a lot of things to be very, very worried about. This is not a moment for complacency. There are any number of reasons why we might feel cheerful, why we might feel we have done a good job, but we are literally on a knife edge."

He said "a lot more money" was needed and urged "dear friends from the other G7 countries" to step up.

He added: "Yes, it’s complex, yes it’s very difficult, yes, the root causes are difficult to address, but we are in a very, very fragile situation. Again, there are some donors around this table who can somehow believe it’s all funded.

"To put it very bluntly we have about half the number of WHO staff that we should have doing preparedness in places like Burundi and South Sudan because the money is simply not coming through."

The Goma case, identified on Sunday, involves a pastor who travelled to the city by bus from Butembo, 300 km away, passing three Ebola control points along the way. At each checkpoint he gave a different name and said he felt well, despite first having symptoms earlier in the week. 

The DRC ministry of health claims all 18 passengers on the bus as well as the driver have been identified and will be vaccinated against the disease. The health clinic the patient first reported to in Goma has also been disinfected. The patient has now been transferred to an Ebola treatment centre in Butembo. 

In a statement the ministry of health urged calm: it said that the speed with which the patient was diagnosed once he was in Goma and the identification of all the passengers on the bus means that the risk of further spread in the city is low. 

The case has prompted Tedros Adhanom Ghebreyesus, director general of the WHO, to convene another meeting of WHO's emergency committee who will advise on whether the outbreak constitutes an international health emergency.

This will be the fourth time the committee has met to discuss this - each time WHO has pulled back, fearing the consequences of any restrictions on travel and trade with DRC. 

“Although this is a very concerning development it's one that we and the government have expected and prepared for. Around 3,000 people have been vaccinated and the pastor is receiving care in an Ebola treatment centre,” said Dr Tedros.

He warned that the case could be a "game changer" in the current epidemic because of the dangers of the disease running out of control in an urban area, close to the border with Rwanda. 

Dr Tedros also highlighted the murder of two Ebola responders over the weekend - the DRC government believes they were targeted by people jealous that they had jobs in the response. 

He said both the case in Goma and the murders highlighted the "challenges we continue to face on a daily basis in DRC. Just when we start to get control in one area [the disease] appears in another. And violence and insecurity continue to undermine the response." 

WHO says that rapid response teams were on the ground in the city first thing this morning, "heading out into communities to provide information, sort fact from rumour and help people to protect themselves".

Professor Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the researchers who first discovered the virus in what was then Zaire in 1976, said he hoped today's meeting would be a “catalyst for improved coordination, high-level political support, and urgent unified action”.

He added: “As we approach the one-year mark of the world’s second largest-ever Ebola outbreak – with nearly 2,500 cases and more than 1,600 deaths in the DRC – there is no evidence that the end of this devastating epidemic is in sight.

"Rather, there is a real risk that this epidemic could further expand, as illustrated by the recent case of a pastor with Ebola disease traveling from Butembo to the major border city of Goma, alongside the ever-present risk of another Ebola outbreak emerging in the DRC or elsewhere.”

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