Kenya, Tanzania on High Alert as Illegal Border Crossings Bring Ebola to Uganda

Travellers at the arrival terminal head to be screened by port health service, at the Jommo Kenyatta International airport in Nairobi on June 17, 2019. - Kenya sought to reassure the public and foreign visitors on Monday after a suspected Ebola case, which turned out to be negative, was detected …

Kenya identified a potential Ebola patient on Monday and Tanzania announced heightened security measures this weekend amid a growing Ebola outbreak that spilled over into Uganda from Democratic Republic of Congo (DRC) last week, the second-worst outbreak of the virus on record.

The director general of World Health Organization (WHO), Tedros Adhanom Ghebreyesus, landed in Uganda on Monday to evaluate the situation after the nation documented its first two Ebola deaths, a five-year-old boy and a woman believed to be his grandmother. The boy, his younger sibling, his grandmother, and several other relatives crossed the border into DRC from Uganda to attend the funeral of his grandfather, a confirmed Ebola victim. A third person has died of the virus since the government announced the first two cases.

The Ugandan Ministry of Health confirmed Ghebreyesus’s visit on Monday. In a statement, spokesman Emmanuel Ainebyoona said that the WHO chief had “come to assess the readiness of the teams on the ground.”

The ministry said Uganda has identified 96 people who have come into contact with the victims and begun administering the Ebola vaccine, which did not exist during the 2014 outbreak, the worst in history, and experts credit it in part with containing the outbreak in the DRC until now. The spokesman added that news of growing numbers of Ebola cases were unsubstantiated.

Despite the effective contact tracing, Ugandan media reported last week that three people identified as potential Ebola patients escaped their local hospital and are believed to have fled into DRC. Among the biggest challenges facing medical staff in the region trying to contain the outbreak is widespread distrust from the locals, who trust traditional healers and believe that either Ebola does not exist or that Western-style health workers are deliberately infecting people with Ebola.

Ugandan health workers have also expressed concern that they are unprepared for a major influx of Ebola patients if they have to act to save them. Hospital staffers in key border regions have complained of not having a reliable isolation ward to keep the virus from spreading, lacking key supplies like gloves, and lax rules on letting individuals potentially exposed to Ebola sit out the incubation period at home, where they may endanger others.

In Kenya, authorities announced Monday that they were testing a woman for Ebola after visiting Uganda, but not DRC, along with several relatives also under observation. The woman is reportedly the only one showing symptoms of Ebola virus disease, which typically presents with fever, hemorrhaging, and vomiting. Medical authorities put the suspected patient in isolation.

“The rapid surveillance and response team, which has been sent to examine the patient who is in stable condition, has confirmed that she does not fit the case definition of Ebola. Allow me to repeat to Kenyans that the patient does not meet the case definition of Ebola,” Kenyan Health Minister Sicily Kariuki said. “Precautionary measures have, however, been put in place including isolation of the patient and submission of blood samples … for testing.”

Tanzania issued an Ebola “alert” Sunday despite not yet having evidence of any potential cases, citing the geographical proximity of the country to the area where doctors have identified cases. Unlike the government of Kenya, which emphasized the low likelihood of an Ebola outbreak there, Tanzania’s health minister issued a stern warning to all to remain vigilant.

“I want to alert the public that there is the threat of an Ebola epidemic in our country,” Health Minister Ummy Mwalimu said on Twitter. “Given that this disease transmits very easily and very quickly from one person to another, nearly the entire country is in danger.”

Tanzania borders Kenya and Uganda and shares a border across Lake Tanganyika with DRC.

Experts have noted that the failure of governments in the region to implement strict border crossing procedures could allow the virus to spread throughout the continent rapidly. Ebola spreads through the bodily fluids of an infected person. In the 2014 outbreak, many people fell ill after handling the body of a deceased relative in traditional burial procedures that require touching and cleaning fluids. Western African governments ultimately forced families to burn the bodies to stop the outbreak, but those who did the difficult job of violating tradition and burning the bodies never recovered from the social stigma.

As noted above, the Ugandan Ebola cases resulted from the victims’ presences at a funeral for another Ebola victim. Border authorities did not identify the family as an Ebola threat when they crossed because they did not enter legally.

“We now know that a family of 14 travelled from the DRC to Uganda. Most of them crossed at the formal border, but five evaded the main port of entry,” Professor Mosoka Fallah told Africa’s the Conversation in an interview published Saturday.Instead they crossed over informally. Those five arrived with symptoms that included diarrhoea and bleeding. This implies a period of illness in the DRC and that they were most likely symptomatic while travelling.”

“It appears they knowingly evaded the official check point that would have monitored their temperature and physical signs to pick them up as possible Ebola cases,” Fallah suggested.

The professor noted that these behaviors also helped Ebola to spread in 2014, saying:

There are a lot more informal crossings than the formal ones. The surveillance system for scanning people who are crossing into Uganda are at these formal crossings. This isn’t always foolproof. When I was working in Liberia during the West African epidemic between 2014 and 2016, we found that some people would take antipyretic medications to avoid being detected at the formal border crossings. These drugs bring fevers down so that scanners don’t detect a high temperature.

You may wonder why people would do this. The reality is that people across geographical boundaries don’t have any physical boundaries in their minds. When they are in the DRC and fall ill, they will do what anyone would: seek support from their relatives and friends, some of whom are in border towns.

Uganda and DRC agreed to send six now-confirmed Ebola patients related to those who died in Uganda back to the DRC.

“They proposed to repatriate six Ebola patients back to DRC to enable them access medicines for therapeutic treatment which are available in the DRC as well as receive family support and comfort since they had six other relatives who had remained behind in DRC and five of whom had also been confirmed positive for Ebola,” Ugandan Health Minister Jane Ruth Aceng stated.

According to the WHO, the current outbreak has affected over 2,000 people. About 70 percent of those have died.

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