Two dying Ebola patients were spirited out of a Congo hospital by their relatives on motorcycles, then taken to a prayer meeting with 50 other people, potentially exposing them all to the deadly virus, a senior aid worker said Thursday.

Both patients were vomiting and infectious and died hours after the prayer session in the river port city of Mbandaka, Dr. Jean-Clement Cabrol, emergency medical coordinator for Medecins Sans Frontieres (Doctors Without Borders), said.

Democratic Republic of Congo is racing to contain an outbreak of the disease, which spreads through contact with infected bodily fluids including vomit and sweat.

The Health Ministry said late Thursday that a new case had been confirmed in the town of Bikoro and another in the nearby village of Iboko, where the epidemic is thought to have started.

This brought the total number of confirmed cases to 31, it said in a statement, out of 52 suspected cases.

Ninth outbreak in Congo

Congo’s ninth recorded outbreak of the disease is thought to have killed at least 22 people so far, according to government figures released Wednesday, fewer than the last estimate of 27, after some of those deaths turned out not to be Ebola.

“The escape was organized by the families, with six motorcycles as the patients were very ill and couldn’t walk,” Cabrol told a news briefing in Geneva after returning from the affected region. “They were taken to a prayer room with 50 people to pray.

“They were found at two in the morning, one of them dead and one was dying. So that’s 50-60 contacts right there. The patients were in the active phase of the disease, vomiting.” The patients got out of the isolation ward Monday.

Earlier reports did not give details of the escape or where they went afterward. A third patient who left the ward survived.

Health officials started trying to trace the motorcycle drivers and other people who came into contact with the patients as soon as the escape was reported, Dr. Peter Salama, head of emergency response at the World Health Organization (WHO), told Reuters on Thursday.

“From the moment that they escaped, the (health) ministry, WHO and partners have been following very closely every contact,” he said.

‘Hard to predict’

WHO’s three-month budget for the crisis has been doubled to $57 million to carry out a complex operation in a remote, forested area, Salama said.

“All it takes is one sick person to travel down the Congo River and we can have outbreaks seeded in many different locations … that can happen at any moment. It’s very hard to predict,” he said, referring to the river linking the trading hub of Mbandaka to the capital Kinshasa, whose population is 10 million.

“It is going to be at least weeks and more likely months before we get this outbreak fully under control,” Salama said.

There have been major advances in medical treatment of the virus since it ravaged West Africa in 2014-2016, including the use of an experimental vaccine to protect medical staff.

But local skepticism about the dangers and the need to isolate infected patients continue to complicate efforts to contain it. In past outbreaks, mourning relatives have caught the hemorrhagic disease by touching the highly contagious bodies of dead loved ones, sometimes by laying hands on them to say goodbye. 
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A pill could soon radio signals from inside your gut to help doctors diagnose diseases from ulcers to cancer to inflammation, according to a new study.

Scientists have developed a small, ingestible capsule that mixes synthetic biology and electronics to detect bleeding in the digestive tract.

The system can be adapted for a range of medical, environmental and other uses, the researchers say.

The biological part of the pill uses bacteria engineered to glow when exposed to heme, the iron-containing molecule in blood.

The electronic side includes a tiny light detector, computer chip, battery and transmitter that sends data to a cellphone or computer.

“A major challenge for sensing in the GI tract is, the space available for a device is very limited,” said Massachusetts Institute of Technology electrical engineer Phillip Nadeau.

Using very low-power electronics that Nadeau and his colleagues designed, they fit all the components into a capsule about 3 centimeters long by 1 centimeter wide.

It’s still a bit big to swallow, but Nadeau says it likely can be engineered to a third that size.

The engineered bacteria are contained in chambers covered by a membrane that lets small molecules in, but does not let the organisms out. The researchers say the bacteria can be engineered to die if they accidentally leak from the capsule; or, future models may just use the key enzymes, rather than whole bacteria.

In laboratory tests, the pill successfully distinguished pigs fed small amounts of blood from those not given blood. The capsule has not been tested on humans, but the team aims to do so in the next year or two.

Since the components are all fairly inexpensive to manufacture, researchers speculate that the cost would be in the range of tens to hundreds of dollars.

And they say the same platform could be used to detect markers of a range of illnesses, or to sense chemicals in the environment.

“It’s really exciting, and I think it’s got a lot of legs,” said Rice University bioengineer Jeff Tabor, who was not part of the research team.

But Tabor notes that the sensors may need to be much more sensitive than what was used in the pig tests. He says there may be much less blood in the guts of actual patients than what the pigs were given. Other conditions may have the same limitations.

“For many actual diseases, you might have far less of the molecule that you need to sense available to you,” he added.

The research was published in the journal Science. 
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President Donald Trump’s top health official said Wednesday that the U.S. and global partners will “take the steps necessary” to try to contain a new Ebola outbreak, asserting that the fight against infectious diseases is one of the administration’s top priorities for the World Health Organization, the U.N. agency taking the lead. 

Secretary of Health and Human Services Alex Azar stopped short of predicting whether the outbreak in Congo that’s believed to have killed at least 27 people will be contained, but he praised WHO’s early response and vowed: “If it spreads, we will take further actions.”

Azar’s comments on Ebola came in a wide-ranging interview with The Associated Press, which also touched on universal health care, U.S. prescription-drug prices, and the recent revelations of a $1.2 million payout by Swiss drugs giant Novartis last year to Trump’s personal lawyer, Michael Cohen. 

Novartis, one of the world’s largest pharma companies, said Cohen was hired to advise on how the Trump administration might approach health care policy. Experts have pointed out that Novartis needs FDA approval for the sale of its drugs and that company officials have spoken approvingly of rolling back the Obama-era Affordable Care Act, a Trump campaign promise largely unfulfilled.

“I don’t and won’t comment on the particulars of any individual situation,” said Azar, a former executive with drugmaker Eli Lilly. 

“The president has talked about how extensively ‘pharma’ generally spends money on lobbying. And we have said: You really don’t need to spend that money on lobbying because the president and the secretary have been very transparent about where we are going with drug prices: We’re going to lower drug prices in the United States,” he said.

The response to the Ebola outbreak by WHO and its director-general, Tedros Adhanom Ghebreyesus, has emerged as a major concern as ministers like Azar and his counterparts from other nations gather this week for the World Health Assembly in Geneva. The conclave lays out the agenda of the U.N. agency, which reaps hundreds of millions in U.S. funding each year.  

“I think it best not to make predictions when dealing with infectious disease,” Azar said cautiously, when asked if the outbreak will be contained. “We will take the steps necessary, we will act aggressively, forcefully, in partnership across the world community to do everything to contain it.” 

“I think that what we’re seeing is that we’re taking it very seriously from Day One,” he said. 

A day earlier, Azar told the Assembly the U.S. was committing an additional $7 million for the Ebola response, raising its total to $8 million. The WHO has launched a “strategic response plan” for itself and partner organizations that seeks nearly $26 million to battle the outbreak, a figure that’s expected to rise.

“We’re also grateful for other countries that have stepped up to the plate. And we hope others will do the same,” Azar added. 

Azar said the “first and foremost mission” that the U.S. and the world community look to the WHO for is its “central role around infectious disease and emergency preparedness and response.”

Azar also underscored a Trump administration grievance: that other developed countries are “free riding off U.S. investment and innovation” in medicines and health care. The White House says countries that regulate the price of drugs contribute to higher costs in the U.S. and keep their own costs artificially low.

Azar said he delivered that message to his peers in Geneva.

“It has been a thoughtful response,” he said, when asked about their reaction. “It has not been reflexive, it has been a sense of, ‘We’re in this together. We do need to work to support innovation.’”

But he said he was leaving the details to others.

“I’m not here to do trade negotiations. I have delivered the message and said our trade negotiators are coming: Be ready!” he said with a laugh. “I have said we have our own job: The president is going to bring down American drug costs. But they’ll have their job.”
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When Ebola broke out in West Africa in 2014, no one was prepared. A potential vaccine had been in limbo since a previous outbreak a decade earlier. Governments dragged their feet while failing to recognize the risks the outbreak carried. Local health workers were quickly overwhelmed. And aid agencies were scrambling to catch up.

By the time the epidemic was brought under control in 2016, more than 11,300 people had died in Guinea, Liberia and Sierra Leone and the costs had risen to $4.3 billion.

Flash forward to May 8, when word emerged about a possible Ebola outbreak in a remote village in the Democratic Republic of the Congo. Within two days, the DRC had dispatched experts to the scene. International agencies shipped in personnel, mobile medical labs and a batch of vaccine that had been tested during the West African outbreak. 

Painful lessons from the last Ebola outbreak are being applied in the current one, in hopes of limiting its scope. 

‘Quick and robust response’

“The coordinated action is essential,” said Tarik Jasarevic, spokesman for the World Health Organization (WHO), which so far is reporting 27 deaths among 51 cases of hemorrhagic fever. “We know how damaging Ebola can be in the communities. And we have to mount a quick and robust response not to get to the point where a transmission chain would get out of control.”

But concerns remain that the virus could elude containment efforts. 

The aid group Medecins Sans Frontieres (MSF), or Doctors Without Borders, reported that three patients left an isolation ward at a treatment center in the Congolese city of Mbandaka sometime between Sunday and Tuesday. Two of the patients died; a third had been scheduled for discharge.

“You can imagine having the Ebola virus in a community is a cause of concern for the local population,” Jasarevic said. The city has roughly a million residents.

The Associated Press quoted MSF emergency coordinator Henry Gray as saying in a statement Wednesday, “One of the men died at home and his body was brought back to the hospital for safe burial with the help of the MSF teams; the other was brought back to the hospital yesterday morning and he died during the night.”

Every epidemic has its unique challenges. In this case, the villages initially affected were in remote locations. Land had to be cleared, first for helicopters and then planes.

With quick action came the need for funding. Last Friday, the WHO requested $26 million. More than half of that had been pledged as of Tuesday, with the United States committing $8 million of the amount.

“It’s better to spend more today than to be forced to spend much, much more afterward, because we know what damage, economic damage, was done to the countries in West Africa in 2014,” Jasarevic said.

Jasarevic said the requested amount was small, given the costs of the last outbreak.

One upside

The repeated outbreaks have had the positive side effect of developing a core of health workers whose experience is proving priceless, including those in the DRC, now dealing with its ninth outbreak. 

“Obviously, they are leading the response,” Jasarevic said of the Congolese. 

He added that WHO also had created an international emergency medical team roster, which includes experts who’ve participated in previous outbreaks. 

The experts include anthropologists and others, who can help explain how individuals can safeguard themselves and others. The experts can instruct that anyone showing symptoms consistent with the virus, such as flu-like symptoms, “should be brought to the treatment center so they don’t affect other people,” Jasarevic said.

The experts also want to increase awareness of safe burial practices, limiting exposure to the body of someone who has died of the infectious disease. It can spread through direct contact with bodily fluids.

The bottom line now is to keep the outbreak from spreading.

The vaccine is being used first on health workers and the friends and relatives of those who already have been infected. If it all works, the aid agencies and various governments soon will be looking for new lessons. 
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Rising levels of planet-warming gases may reduce key nutrient levels in food crops, according to a new study.

Rice grown while exposed to carbon dioxide levels expected by the end of this century had lower levels of vitamins, minerals and protein than normal, the results showed. 

The authors said the impact would be most significant for the poorest citizens of some of the least-developed countries, who eat the most rice and have the least diverse diets.

In the study, published in the journal Science Advances, scientists grew 18 varieties of rice in fields in China and Japan. They pumped carbon dioxide over the plants to simulate the atmosphere of the future. 

Rice grown under high carbon dioxide conditions had, on average, from 13 to 30 percent lower levels of four B vitamins, 10 percent less protein, 8 percent less iron and 5 percent less zinc than conventionally grown rice. 

On the other hand, vitamin E levels increased by about 13 percent on average.

The results are bad news, “especially for the nutrition of the poorer population in less-developed countries, because this population depends for nutrition on rice,” said study co-author Kazuhiko Kobayashi at the University of Tokyo. 

That includes roughly 600 million people in Indonesia, Cambodia, Myanmar, Bangladesh, Laos and several other nations, mainly in Southeast Asia, the report said.

While research has shown higher temperatures from climate change and weather extremes will cut food production, especially in the tropics, scientists are increasingly finding that rising greenhouse gas levels are a threat to food quality as well.

Earlier studies by Harvard University researcher Sam Myers and colleagues showed that wheat, maize, rice, field peas and soybeans grown under high carbon dioxide conditions all had lower levels of protein and minerals. The scientists estimated that roughly 150 million people might be at risk of protein or zinc deficiency by 2050. 

It’s one example of the surprises climate change has in store, Myers said.

“If you and I sat down 15 years ago and thought about, ‘I wonder how dumping enormous amounts of carbon dioxide into the atmosphere will affect our well-being,’ I think one of last things we would have come up with is, ‘I bet it will make our food less nutritious,’ ” he said.

“My concern is, there are many more surprises to come,” Myers added. 

He noted that global pollution, biodiversity loss, deforestation and land use change, and other human activities are likely to produce unexpected problems as well.

“You can’t fundamentally disrupt all the natural systems that we have adapted to over millions of years of evolution without having these ripple effects that come back to affect our own health and well-being,” he said.

The new study suggests a way to minimize the nutritional impact of climate change.

“Different [rice] varieties showed quite different changes in response to higher carbon dioxide concentrations,” Kobayashi said. Rice breeders can use these differences to create varieties that are less affected by greenhouse gas levels, he said.
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Health Experts at the World Health Assembly in Geneva agree the next few weeks will be crucial in determining whether the Ebola outbreak in Democratic Republic of Congo can be contained and prevented from spreading to highly-populated urban areas.

Two weeks have elapsed since the first laboratory-confirmed case of Ebola was discovered in the remote, rural town of Bikoro in DR Congo’s northwestern Equateur Province.

Soon after the Ebola outbreak was declared May 8, World Health Organization Director General Tedros Adhanom Ghebreyesus and several associates went to the region to assess the situation.

Tedros said he was pleased by the government’s quick response.

“The government had already triggered the community committees so that communities can take the ownership and contribute, and they are going house to house to identify cases and to identify contacts.Starting from the Government leadership, everything is triggered,” he said. “We are watching it around the clock, 24/7, and we hope it will have a better outcome.”

This rapid response to the current emergency is a sea change from the way the WHO and other agencies reacted to the West African Ebola epidemic.More than 11,000 people were killed before it was brought under control in 2016.

This is the 9th Ebola outbreak in DRC since the disease was simultaneously discovered in DRC and South Sudan in 1976. In the eight previous outbreaks, Ebola occurred in either isolated rural areas or in small towns where the disease remained largely confined.

Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response, said the current outbreak has features of two previous typologies — a combination of rural villages, and larger towns and cities. These factors “have given us concern that the outbreak has the potential to expand,” he said.

“First is the involvement of a town — Mbandaka — which is the capital of the Equateur Province in that region with a population of more than 1 million people,” he added. “Secondly, that town is on the Congo River and its tributaries, which ultimately connects this outbreak potentially to Kinshasa and also to surrounding countries such as the Republic of Congo and the Central African Republic.”

He said five health care workers in Mbandaka have been infected with the virus, which is a potential signal for further amplification. He noted there are 58 confirmed and suspected cases of Ebola, including 27 deaths.He said health agencies and the government are actively following 600 contacts to learn the specific locations of the outbreak.

“It is really the detective work of epidemiology that will make or break the response to this outbreak,” he said. “It is documenting how people are getting infected and, therefore, managing control, the control of transmission. … We are following three separate chains of transmission, and each one has the potential to expand, if not controlled.”

One potentially powerful tool for containing the spread of Ebola is an experimental, protective vaccine that was not available during the West African epidemic. More than 7,500 doses of the vaccine have been sent to DRC.

Salama said a ring vaccination program began Monday in Mbandaka.

“This is not mass immunization,” he noted. “This is highly targeted ring vaccination where concerned or probable cases are identified and then each and every contact is traced and vaccinated, and then the contacts of those contacts are then traced and vaccinated, forming protective rings around that case — to protect the people themselves — the contacts, but also to prevent further community transmission.”

Salama said this is the same approach used in the 1970s for the elimination of smallpox.

Regional risk

On a regional level, the World Health Organization has designated nine neighboring countries, which share porous borders with DRC at high risk of Ebola. Those most at risk are the Republic of Congo and Central African Republic.The others include Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and Uganda.

WHO Regional Director for Africa, Matshidiso Moeti, said WHO is helping these countries scale up preparedness so they can detect, investigate, and manage the disease.

“We are helping countries to pre-position the supplies that they will need, including personal protective equipment, infra-red thermometers, rapid diagnostic test kits and other critical supplies,” said Moeti. “We are working with members states and partners at all levels to scale up surveillance, detection, case management at the border areas surrounding the Democratic Republic of the Congo.”

Salama said the exceptionally rapid, robust response to the outbreak and strong multi-partner effort bodes well for the work ahead.

“It is not over yet,” he cautioned. “We are really just at the beginning … we are on the epidemiological knife-edge of this response.The next few weeks will really tell if this outbreak is going to expand to urban areas or if we are going to be able to keep it under control.”

The World Health Organization is appealing for $26 million to keep the operation going for the next six months.It says strong, continued international support is essential for combating this deadly disease.
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Two infected patients who fled from an Ebola treatment center in a Congo city of 1.2 million people later died, an aid group said Wednesday while asserting that “forced hospitalization is not the solution to this epidemic.”

As the number of suspected Ebola cases continued to rise, experts emphasized that more community engagement is needed to prevent the spread of the deadly virus.

Three patients left of their own accord from the isolation zone of the Wangata hospital in Mbandaka city between Sunday and Tuesday, said Henry Gray, emergency coordinator for Medecins Sans Frontieres.

One patient had been about to be discharged, he said.

“The two others were helped to leave the hospital by their families in the middle of the night on Monday. One of the men died at home and his body was brought back to the hospital for safe burial with the help of the MSF teams; the other was brought back to the hospital yesterday morning and he died during the night,” Gray said in a statement.

Hospital staff made every effort to convince the patients and their families not to leave and to continue treatment, Gray said.

Three Ebola deaths have been confirmed since Congo’s health ministry announced the current outbreak of the often lethal hemorrhagic fever on May 8. It was not immediately clear if the two deaths reported by MSF were confirmed Ebola ones.

Congo’s health ministry on Wednesday announced six new suspected cases in the rural Iboko health zone in the country’s northwest and two in Wangata. There are now 28 confirmed Ebola cases, 21 probable ones and nine suspected. Overall the death toll stands at 27.

“We’re on the epidemiological knife’s edge of this response. The next few weeks will really tell if this outbreak is going to expand to urban areas or if we’re going to be able to keep it under control,” Dr. Peter Salama, the World Health Organization emergencies chief, told a World Health Assembly session Wednesday.

Worrying factors include the spread of confirmed cases to Mbandaka city and the fact that five health workers have been infected, signaling “a potential for further amplification,” he said. Front-line workers are especially at risk of contracting the virus, which spreads in contact with the bodily fluids of infected people, including the dead.

Finally, Salama said, the outbreak has “three or four separate epicenters,” making it more challenging to contain. “It’s really the detective work of epidemiology that will make or break the response to this outbreak. It’s documenting how people are getting infected and therefore managing to control the transmission,” he said.

“We are following three separate chains of transmission,” he said. “One associated with a funeral that took place in a neighboring town of Bikoro; one associated with a visit to a health care facility more than 80 kilometers (50 miles) away in the small village of Iboko and one where we’re still gathering data on that’s related to a church ceremony.”

WHO is accelerating efforts with nine countries neighboring Congo to try to prevent the Ebola outbreak from spreading beyond the border.

The top two priorities are Central African Republic and the Republic of Congo near the epicenter of the outbreak, Matshidiso Moeti, WHO’s director for Africa, told the WHA session. The other countries are Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and, to a lesser extent, Uganda.

WHO began vaccinations this week and is using a “ring vaccination” approach, targeting the contacts of people infected or suspected of infection and then the contacts of those people. More than 600 contacts have been identified, WHO said.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.

The UK on Wednesday pledged another 5 million pounds ($6.6 million) to help combat the outbreak.

WHO Director-General Tedros Adhanom Ghebreyesus said simply: “We are watching it around the clock, 24-7.”
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