How Uganda Stopped Ebola So Quickly

According to Dr. Amy Boore, Director of Global Health Protection at the CDC, one of the reasons Uganda stopped Ebola so quickly was due to identifying the species of the virus as the Sudan species.

Dr. Hadson Kunsa, an intern at the 90-mile-away Mubende Regional Referral Hospital in Uganda, had a routine day. According to testing, a woman who presented with significant abdominal pain had a perforated stomach. When he finally arrived for surgery, it was too late. No amount of resuscitation could save some of his shut-down organs.

At the time, Kunsa and his coworkers were unaware that they had just been exposed to Ebola, a rare and contagious virus with a death rate of up to 90%.

The warning indicators have been there in the past. It was the middle of September 2022, and earlier that week, a few other patients who had experienced similar symptoms had passed quite unexpectedly. The head of the hospital in Mubende stated, “One died on arrival at our hospital.”

However, nobody was able to figure out what was happening. The hospital staff visited the nearby villages of Madudu after looking at these inexplicable deaths. Batiibwe said, “We found nine deaths had already occurred, and the locals were also suspicious that something was wrong.

It was difficult to determine the true scope of whatever this outbreak was because many families in these communities had purportedly been seeking care from traditional healers. In one of the hardest-hit districts, Kassanda, community leader Silvest Lwambuka said, “Seeing people falling very sick at once and then dying one after another was strange.” Many people sought out traditional healers to drive these evil spirits away rather than visiting the hospital. Some of these treatments involved chanting certain, spiritual words and drinking a mixture of regional herbs. Lwambuka stated that going to the hospital was their only other choice.

When a 24-year-old male with a bleeding nose eventually arrived at the hospital in Mubende, a sample was immediately obtained for analysis and returned on September 19. It was the Sudan Variant of Ebola, a type that is particularly dreaded because there is neither a vaccine nor a treatment for it.

Days later, Kunsa and a number of his coworkers began suffering from fierce fever attacks, a sharp decline in appetite, excruciating bodily aches, and severe diarrhea. As Kunsa came to terms with what this would imply for his personal health as well as his professional responsibilities in the coming days, he stated, “I remember thinking of running away, anywhere, to avoid my reality.”

In a few days, four healthcare professionals and a hospital driver all passed away. In nearby smaller community clinics, two other healthcare professionals also passed away. The hospital staff was overcome with morbid terror, uncertainty, and grief.

Batiibwe said the words, “We hurt,” in a whisper.

Governments and the media worldwide began to paint a bleak picture of Uganda’s ability to control the outbreak as word of the positive Ebola tests spread, especially as cases expanded outside of Mubende. Later, The Telegraph would publish a secret estimate claiming 500 people will pass away by April 2023. More than 11,000 people died during a massive outbreak that swept through Liberia, Guinea, and Sierra Leone from 2013 to 2016. These events are still vivid in people’s minds, and any new cases in the intervening time period sparked terrifying news reports. The WHO Country Representative, Yonas Tegen, called these findings dramatic. As tourists postponed their vacations to Uganda, the nation’s tourism industry began to suffer.

The US recommended its people postpone travel to Uganda on October 11 and instituted extra screening for those who had been to or were passing through the nation. According to Anne Robins, the UNICEF Chief of Child Survival and Development, “we anticipated that it would take 1-2 years to manage the outbreak, especially as Ebola cases presented in a complex urban setting such as Kampala.”

Senior army medical officials were urged by Uganda’s 78-year-old President Yoweri Museveni, a military strongman who has been in power since 1986, to spearhead the effort to combat the disease.

In Kampala, there was speculation of a potential lockdown, but most of the city continued as usual despite some people donning masks and crowded malls asking guests to wash their hands before entering.

Eventually, schools were closed, and some health professionals pushed for a wider lockdown, but authorities soon rejected the suggestion. Dr. Richard Kabanda, the interim commissioner of health services, said that the public as a whole was sick of epidemics and that many people did not believe another one had broken out barely a year earlier.

Instead, the health ministry decided to start a public awareness campaign on the virus. The education effort, in the opinion of the authorities, was the most effective component of the reaction. Thousands of fliers with advice from health professionals urging individuals to get care were swiftly distributed. One said, “Your chances of survival and recovery are much higher if you seek early treatment and care from qualified health workers.”

Authorities made use of a network of hundreds of Village Health Trainers (VHTs), who serve as the Health Ministry’s initial point of contact with the local population and are known for helping to spread immunization calls and family planning information. These people, who were well-liked and trusted in their local communities, went door to door spreading awareness while carrying portable megaphones.

“As we moved, we would also collect any information about who was not feeling well, and if the symptoms were similar to Ebola, we forwarded the details,” Anna Nalubega, a VHT in Kassanda, said. 

“We gave people our numbers to call at any time, and we notified the district Ebola teams when they did,” Fedris Nambooze, also a VHT, added. Many VHTs had also been deployed during the COVID-19 outbreak, and we’re now doing the painstaking work of educating a populace on a unique virus all over again. 

On November 12, WHO’s Tegen told the media that only five cases had tested positive for Ebola that week and that the number of cases had dramatically decreased over the preceding three weeks.

Bbosa said that there were no patients in Kampala, where a large medical facility had been established. “By mid-November, there were 300 unused beds at the National Referral Hospital alone in anticipation of a rise in patients,” Bbosa explained.

No new cases have been found since late November, and on January 11th, Uganda and the WHO declared the outbreak to be over. In the end, the WHO reported 142 confirmed cases of Ebola, 55 fatalities, and 87 recoveries; the CDC reported an additional 22 likely fatalities from undiagnosed cases, and almost 4000 contacts were identified. The actual figures are much lower than the initial predictions of over 500 fatalities made at the beginning of the outbreak.

Since then, the focus of the programs has switched to the patients who have been discharged but who still require assistance, according to the local team. The health ministry has since developed Ebola survivor programs alongside humanitarian organizations like USAID.

“There are clinical issues that remain once you are discharged,” Dr. Sarah Page, the USAID Global Health Security Agenda Advisor, explained. “For many survivors, they experience headaches, joint pain, and sometimes you can have the virus persisting in breast milk and semen.”

The survivor clinics in Uganda continue to support weaned infants and do stringent 72-hour mobile testing of nursing mothers. Not to mention the programs that track survivors’ mental health and provide emotional assistance.

Today, finding patient zero is a top priority as survival monitoring continues. According to Dr. Amy Boore, Director of Global Health Protection at the CDC, the entire world is hoping Uganda would be the first nation to announce this crucial information, which has evaded every Ebola outbreak. Numerous investigations are currently being conducted, and an animal reservoir is suspected. “We don’t know which one, but Uganda’s Ministry of Health is leaning in hard with the Wildlife Authority as well to up the game with ecologic studies,” she says. This time, they’re quite determined to find an answer, and if they do, it will be for the benefit of everyone.

She applauds the nation for promptly differentiating between the several Ebola strains. She continues, “Uganda is one of the few places on the planet that could have identified the Sudan species.

“Uganda has been a good example within the African continent to the extent that some other countries have had their samples tested here,” continued Emmanuel Ainebyoona, the Spokesperson for the Health Ministry. Contrary to what some stories in international media had projected, the entire response lasted less than four months.

The UN has offered similar praise. The Director General of the WHO, Tedros Adhanom Ghebreyesus, stated in a video message last month, “I congratulate the government, health care workers, and the people of Uganda, for your leadership and dedication, which have enabled this Ebola outbreak to be contained in less than four months.” “Even in the absence of approved vaccines and therapeutics for this specific Ebola, Uganda was able to use proven public health tools to contain the outbreak.”

“We commend the Ugandan government in leading efforts to put a swift end to the spread of the Sudan ebolavirus which spurred the outbreak, the US government said in a statement. “A major accomplishment in such a short time.”

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In the end, Boore attributes the bulk of the success to the Ugandan people. “Everything that Ugandans do, they do with absolute effort; people do not reserve energy till the end,” she said. “The story of Uganda and Ebola from 2000 until now is inspirational.”