NAIROBI/GOMA, Congo — Guylaine Masika, a nurse in the city of Butembo, in the eastern part of the Democratic Republic of the Congo, fell ill from Ebola in September 2018, after unknowingly treating an infected person.
She was among the first victims of Ebola in her city, which led to her entire extended family ostracizing her. She is a widowed mother of four. For her, the impacts of her Ebola infection have been lasting.
"I continue to experience stigmatization at the societal level. I can't forget these pains in my life,” she said.
Now, the news that COVID-19 has come to DRC has added to her burden of stress. She worries about the impact the disease could have on her body, if she were to contract it, given the long-term toll that Ebola might have had on her immune system.
For those living in the Eastern Congo, COVID-19 comes to complicate an already complicated situation, as the region struggles from both armed conflict and an Ebola outbreak that has lasted nearly two years and infected thousands.
There was cautious optimism that the Ebola outbreak was over. But two days before the World Health Organization could declare its end, on April 10, a new case emerged.
Now, there are seven confirmed Ebola cases. This includes four deaths, one recovery, one person in ongoing treatment, and one who escaped from the treatment center. There are about 1,000 personal contacts that have been linked to these cases.
The person who escaped from the treatment center is believed to be in an area with armed groups, making it difficult for health workers to find him, said Michel Yao, WHO’s emergency operations manager in Africa.
It is concerning that there haven’t yet been new cases identified, as a result of this case, given that he has been in the community for over two weeks, said Trish Newport, deputy manager of Médecins Sans Frontières’ Ebola programs in DRC.
“The messages we are getting from the community regarding COVID is one of very, very deep fear — even deeper and stronger than what we had at the highest of the Ebola outbreak.”— Robert Ghosn, operation manager for the Ebola response, IFRC
“There's the risks that the outbreak could blow up all over again, if you have cases in the community that are not identified,” she said.
Managing both outbreaks
Luckily, COVID-19 has not yet hit eastern DRC in large numbers. Health authorities have reported only 13 confirmed cases in the region, according to WHO. Cases have been sporadic and widespread community transmission has not been detected.
Ebola response activities are largely able to continue amidst the pandemic, with new messaging on COVID-19 integrated into the response, said Pauline Schibli, Ebola programs director at Mercy Corps.
Some activities had to be stopped because of COVID-19, including some community outreach campaigns on Ebola that involved mass gatherings, such as meetings at churches or mosques, said Robert Ghosn, operation manager for the Ebola response for the International Federation of Red Cross and Red Crescent Societies. But there are still ongoing door-to-door campaigns, with precautions, and interactive radio programs.
But moving forward, the response could be severely hampered if there were a strict lockdown in the region, although this type of lockdown in eastern DRC is not anticipated in the near future, Schibli said. This could impact efforts to treat Ebola patients and conduct contact tracing.
There are concerns that more Ebola cases could also emerge from survivors of the disease, because it’s possible their bodily fluids, particularly through sexual contact, can cause new infections, according to Dr. Olivier Ngadjole, health adviser to Medair DRC.
While some parts of the Ebola response are similar to that of COVID-19, there are also stark differences. COVID-19 is much more contagious, while Ebola is much more deadly.
What exactly needs to change? Different organizations involved in the response point to some common issues: better coordination, clarification of roles, and concretization of community engagement.
Ebola responders learned the hard way that telling people what to do, without listening to them, doesn’t work, Ghosn said. Community messaging has to be adapted. For example, it might not work to impose social distancing in eastern DRC because of COVID-19 because of people’s need to earn a daily wage. A health responder instead might need to go to the market with community members and strategize how to create more space in the market to keep people apart, for example.
A consortium of NGOs that collects information on community perceptions is finding that there is a lot of confusion and suspicion around COVID-19, Schibli said.
There are questions about whether Ebola still exists or if Ebola has morphed into COVID-19, she said. There are also accusations that the “reintroduction” of Ebola was intentional, a plot by international actors to maintain funding.
Controversies surrounding potential COVID-19 vaccine tests in Africa has also damaged the perception of the Ebola vaccine for some who have conflated the two different vaccines — which has caused some renewed resistance to it, she added.
In the streets of Kinshasa, some young people are heard singing in the language of Lingala: "corona eza té" or "coronavirus does not exist."
From its system that collects feedback from communities, IFRC is seeing that there are also high levels of community concern over COVID-19.
“The messages we are getting from the community regarding COVID is one of very, very deep fear — even deeper and stronger than what we had at the highest of the Ebola outbreak,” Ghosn said.
Dwindling funds, no local testing, economic strain
Resources are now divided between responding to the coronavirus, Ebola, as well as other outbreaks in the region, including measles, WHO’s Yao said. WHO has been forced to tap into its own emergency funds for the Ebola response because donor funding isn’t sufficient, he said.
There are also significant challenges around testing for COVID-19. Samples are collected and sent to Kinshasa for the results, he added.
The restrictions around movement for COVID-19 are more severe than they were for Ebola, which is impacting the local economy. The capital city of Kinshasa is under lockdown, which has repercussions across the country, and the land border with Uganda is closed, which is the source of livelihood for millions of people, Ghosn said.
“COVID is already having very dire humanitarian consequences in eastern DRC, irrespective of the number of cases,” Ghosn said.
Timothée Kyatsi, a 23-year-old cosmetics trader from Butembo, had his goods blocked in Kampala when the border closed. He has been forced to raise the price of his products and has resorted to smuggling some of his goods across the border.
"My business is not doing well because of this corona. My customers tell me that they only have money for their food," he said.
Because of these restrictions, it’s also difficult to bring in more exports and supplies to strengthen the response, as international flights out of the region have stopped, Ghosn said.
But despite the challenges of managing the responses to both diseases simultaneously, there are some advantages that the region has now in tackling COVID-19 because it has gone through the Ebola response.
One is that there are already health experts on the ground. For example, WHO still has more than 200 staff, technical experts, as well as support staff. There is also existing capacity in communities to respond to an outbreak and systems in place for health workers to engage with these communities.
Another is that unlike other countries that are halting vaccination campaigns because of COVID-19, the government of DRC is allowing measles vaccinations to continue. It’s learned that it was possible to conduct these campaigns, with precautions, during Ebola, so it believes it’s also possible during this pandemic, Newport said.
But as the weeks and months wear on, there is concern about capacity if COVID-19 cases were to drastically increase.
The health systems are weak and hospitals are not equipped to fight coronavirus. Mortality rate could be as high as 10% in the country, said Jean-Jacques Muyembe, the doctor leading Congo’s Ebola and COVID-19 responses.
“There is no shortcut here. There's no easy answer. It will be long, and it will be difficult,” Ghosn said.
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