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DRC: Ebola, measles and COVID-19

18 Jun 2020

On 1 June 2020, the Democratic Republic of Congo (DRC) declared its 11th Ebola outbreak, following the revelation of new cases in the Equateur province. 

This comes as the DRC continues to battle increasing cases of COVID-19, in addition to the country’s deadliest measles epidemic– and the largest in the world today. Australian Dr Saschveen Singh, Tropical Infectious Disease Advisor with MSF spoke with Dr Norman Swan for ABC’s Health Report about the challenges in tackling three epidemics at once. 

Three-year-old Mbisa Eme Kosenge, has a fever, rashes and mouth sores caused by measles. She also contracted tuberculosis and is showing signs of malnutrition – a condition amplified by the disease. © Caroline Thirion/MSF
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Norman Swan: Time now for a sobering reality check. Every day we see the devastating effects of the COVID-19 pandemic, so far largely in rich nations like the United States and the UK. But there is a country that is currently experiencing three epidemics at once. The world's largest measles outbreak, COVID-19, and now a new Ebola outbreak, which was declared at the beginning of this month. The nation is the Democratic Republic of the Congo. A Perth-based general practitioner has done tours of duty for Médecins Sans Frontières in the Democratic Republic of the Congo, and is also the tropical infectious disease advisor for MSF. Dr Saschveen Singh, welcome to the Health Report.

Saschveen Singh: Thank you for inviting me onto the show today, Norman.

Norman Swan: Saschveen, it's hard to see how things could have got any worse in the DRC. I mean, there's a civil war that is tearing it apart.

Saschveen Singh: Yes, it's quite a complex setting, and, as you can imagine, responding to any infectious disease outbreak in that sort of context can get extremely complicated. MSF has a long history in the country, we've been there for over 30 years, and have been providing healthcare in many contexts, whether it be nutritional emergencies or routine malaria projects, providing routine health care for pregnant women, and going in to access remote villages to respond to things like measles outbreaks. You did mention the very significant measles outbreak that has been ongoing since the beginning of 2019 and has killed over 6,500 children at this point. But then we have also had the outbreak of Ebola in the North Kivu province, and now this new outbreak in another completely different province, in Équateur in the DRC. And I'll throw on top of that the complexities in providing healthcare in a COVID-19 context. It has been really challenging for our teams.

Norman Swan: What's it like working there? You've done more than one tour of duty there, haven't you?

Saschveen Singh: Yes, I've been there three times, so twice in an Ebola context and once last year also for a measles outbreak response.

Norman Swan: So what's it like working there?

Saschveen Singh: So, as I mentioned, the contexts are challenging, you can imagine. The DRC is a country that is almost the size of Western Europe in itself. Extremely poor road networks, so when you are outside of the main city hubs it can be very difficult to travel into remote areas, and this is where we see the most important health problems in the community, so we see these very severe measles outbreaks in areas that have had inadequate vaccination. There the population have been potentially affected by displacement due to conflict but then also just long-running nutritional emergencies. We see a lot of illness in children, for example, that are malnourished. It can be really challenging for our teams. I found it quite difficult on a number of occasions, particularly working in remote communities affected by measles.

Norman Swan: And has your life been threatened?

Saschveen Singh: No, I was thankfully safe. I was working in North Kivu in the Ebola context, and we did have a few security challenges where there was some outbreak of violence within the town. But MSF has a big focus on protection of their staff and we do try and operate in a very safe manner, and thankfully we have very good community acceptance. That's really part of our security procedure – that we have good communication with the local population – so they understand us, that we are there to help. But yes, it's not without its risks.

Three-year-old Mbisa Eme Kosenge, undergoing treatment for measles in DRC. © Caroline Thirion/MSF

Norman Swan: You've just got one Ebola outbreak under control and then another one pops up. What's the status of drug treatment and vaccine for Ebola? Because I'm a bit confused actually as to whether or not you've got effective interventions these days. I hear that you do, but is that true?

Saschveen Singh: We've actually seen some pretty amazing developments in terms of Ebola vaccines and treatments. We actually have two vaccinations that are available now. So the first one which is the one that has been used quite routinely in the North Kivu outbreak to vaccinate frontline health workers and also to use in a ring strategy to vaccinate the contact cases has been proven to be effective.

In terms of the long-term protection we know that the current studies show that it provides protection for at least 12 months but it could be more, because it is a newer vaccine, it will have more information coming up in the next few years in terms of the long-term immunity. In terms of treatments, you may have heard that there was a randomised controlled trial looking at different therapies for Ebola, two of them which were antibody treatments, a single infusion of an antibody type treatment…

Norman Swan: Was that the ZMapp?

Saschveen Singh: Actually, it wasn't ZMapp. So ZMapp was initially involved in a randomised controlled trial, but Regeneron and mAb114 were two different antibody treatments that was showed in the initial analysis in that study to actually have a superior outcome, so those are the two treatments that are being used currently. They are not fully licensed treatments because they are still under investigational use for longer-term tracking of the patients, but we've seen in this outbreak in North Kivu that we've had some good successes with those treatments, if given early.

Norman Swan: We're almost out of time. Just briefly, is lockdown working for COVID-19 in such difficult circumstances?

Saschveen Singh: As you can imagine, it is quite challenging. For countries that have quite intense density of population, the lockdowns can be an initial measure by governments just to try and contain the outbreak. I think it's a little bit too early to tell. In Kinshasa, for example, in the DRC, which is kind of the epicentre of where COVID-19 is happening at the moment, they had quite significant lockdown measures, but we are still seeing spread in some of the neighbourhoods in Kinshasa, and then now we are also seeing cases in other parts of the country. I think that over the coming weeks to months we will have a better idea about the spread.

Norman Swan: Saschveen, thanks for joining us.

Saschveen Singh: You're welcome, thanks for inviting me on the show today.

Norman Swan: Dr Saschveen Singh is the tropical infectious disease advisor for MSF, and she is also a GP based in Perth.