Health officials in the Congo are trying to stem the deadly Ebola outbreak in the country, which has already spread to an urban area before the situation worsens. But the control of the virus may just have gotten harder.
On Wednesday, the mission "Doctors Without Borders" in the Congolese city of Mbandaka announced that three Ebola patients had left a stationary isolation ward there and reentered the general population.
One patient left Sunday, shortly before discharge, and is still alive, according to the relief group. Two others left overnight on Monday; One died outside the quarantine and another was taken to the hospital and died there.
"In all three cases, every effort has been made by hospital staff to convince patients – and their families – not to leave and continue their treatment," said Brienne Prusak, a spokesperson for MSF, how Doctors Without Borders are often called.
Eugene Kabambi, the World Health Organization spokesman for the Congo, told Reuters that two of the patients' families helped them leave the hospital on Monday and then took them to a church.
"It's unfortunate, but not unexpected" WHO spokesman Tarik Jasarevic said. "It's normal that people want loved ones to be at home in the last moments of life."
Now the question arises with whom the patients might have come in contact when they left the hospital the city of more than 1 million people. There were 58 confirmed, probable and suspicious cases of Ebola – and 27 deaths – on Tuesday. This number could dramatically increase if the disease spread widely in a big city.
Knowing who was exposed to Ebola is also crucial to the effectiveness of the new Ebola vaccine that was used in the Congo. Proper use of the vaccine is based on identifying each person who has come into contact with an infected individual and then working outside, which experts call "rings" of people, which involves contact.
The idea is too fast Immunize those with the highest risk of contracting the virus before they can potentially become infected and spread themselves. Since this week, WHO has announced that 628 such contacts have been listed in Congo.
When Ebola arrived in West Africa in 2014, some of the obstacles that hindered the medical response included lack of trust in communities dealing with outbreaks and religious practices – such as washing the body of the dead – the spread of the disease is contagious due to body fluids. In particular, contact with religious leaders in the community has helped familiarize communities with the right security protocols.
But lack of trust between patients and physicians is often the reason that Ebola sufferers elude treatment, which can be intimidating by their families and only interact with medical professionals in protective suits. Patients also left the hospital in previous Ebola outbreaks even though doctors urged them to do so.
MSF warns against seeing "forced hospitalization" as a solution to the outbreak.
"Patient adherence is of paramount importance," said Prusak. "The faster the patients are admitted, the better their chances of survival and the greater the chance of limiting the spread of Ebola."
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