With the world’s focus on the coronavirus disease 2019 (COVID-19) outbreak, a good news story receiving far less attention is that of Semida Masika, the last person in DR Congo conﬁrmed to have Ebola virus infection and discharged from care after her recovery on March 4. This important milestone is a remarkable achievement given the insecurity in DR Congo, which led to serious attacks on health-care facilities, workers, and patients, and a continual disabling of the outbreak response.
The 18-month Ebola outbreak in DR Congo has claimed 2264 lives and the number of cases exceeded 3000, making it the largest Ebola epidemic ever recorded after the west Africa outbreak of 2014–16. Unlike previous Ebola outbreaks, the national government took charge in coordinating the response, ably supported by WHO, donors, and other partners, including the African Centres for Disease Control and Prevention, which importantly allowed African experts rather than international experts to remain at the front and centre of the response.
Another unique feature was the multidisciplinary approach to the outbreak, which included employing more social scientists, applying new technologies, such as whole genome sequencing, and building community trust and engagement alongside a competent workforce for new surveillance and laboratory capacities. Having vaccines and treatments, plus the ability to conduct trials during the outbreak, was crucial and helped communities to have conﬁdence in the health-care system.
Worldwide, as millions of people stay at home to mini- mise transmission of severe acute respiratory syndrome coronavirus 2, health-care workers prepare to do the exact opposite. They will go to clinics and hospitals, putting themselves at high risk from COVID-2019. Figures from China’s National Health Commission show that more than 3300 health-care workers have been infected as of early March and, according to local media, by the end of February at least 22 had died. In Italy, 20% of responding health-care workers were infected, and some have died.
Reports from medical staﬀ describe physical and mental exhaustion, the torment of diﬃcult triage decisions, and the pain of losing patients and colleagues, all in addition to the infection risk.
As the pandemic accelerates, access to personal protective equipment (PPE) for health workers is a key concern. Medical staﬀ are prioritised in many countries, but PPE shortages have been described in the most aﬀected facilities. Some medical staﬀ are waiting for equipment while already seeing patients who may be infected or are supplied with equipment that might not meet requirem ents. Alongside concerns for their personal safety, health-care workers are anxious about passing the infection to their families. Health-care workers who care for elderly parents or young children will be drastically aﬀected by school closures, social distancing policies, and disruption in the availability of food and other essentials.
Coronaviruses are a group of viruses belonging to the family of Coronaviridae, which infect both animals and humans. Human coronaviruses can cause mild disease similar to a common cold, while others cause more severe disease (such as MERS - Middle East Respiratory Syndrome and SARS – Severe Acute Respiratory Syndrome). A new coronavirus that previously has not been identified in humans emerged in Wuhan, China in December 2019.
Signs and symptoms include respiratory symptoms and include fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome and sometimes death. Standard recommendations to prevent the spread of COVID-19 include frequent cleaning of hands using alcohol-based hand rub or soap and water; covering the nose and mouth with a flexed elbow or disposable tissue when coughing and sneezing; and avoiding close contact with anyone that has a fever and cough.
WHO is working closely with global experts, governments and partners to rapidly expand scientific knowledge on this new virus and to provide timely advice on measures to protect people’s health and prevent the spread of this outbreak.
The detection and spread of an emerging respiratory pathogen are accompanied by uncertainty over the key epidemiological and serologic characteristics of the novel pathogen and particularly its ability to spread in the human population and its virulence (case-severity). This is the case for the COVID-19 virus, first detected in Wuhan city, China in December 2019 (1).
To date initial surveillance has focused primarily on patients with severe disease, and, as such, the full spectrum of the disease, including the extent and fraction of mild or asymptomatic infections that do not require medical attention are not clear. Estimates of the case fatality ratio, and other epidemiological parameters, will likely be lower than current crude mortality estimates once the full spectrum of disease is able to be included in the denominator. In addition, the role of asymptomatic or subclinical infections in human-to-human transmission of COVID-19 virus is not well understood and it is not yet clear whether those who are reported as asymptomatic may be able to transmit the virus to other individuals.
With a novel coronavirus, initial seroprevalence in the population is assumed to be negligible due to the virus being novel in origin. Therefore, surveillance of antibody seropositivity in a population can allow inferences to be made about the extent of infection and about the cumulative incidence of infection in the population.
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