Kai KupferschmidtMay 18

There is a LOT going on as researchers and public health experts are racing to respond to the #Ebola #Bundibugyo outbreak in DRC and Uganda before it grows bigger.

My story in Science Magazine is here (and thread coming):

https://www.science.org/content/article/scientists-play-catch-startling-ebola-outbreak

Show threadKai KupferschmidtMay 19
SIZE OF THE OUTBREAK:
When this outbreak was announced on Friday, the biggest shock to many experts was that there were already 246 suspected cases and 80 deaths. It suggested the outbreak had been building for a while.
As Salim Abdool Karim told me: “It just crept up on us.”
Show threadKai KupferschmidtMay 19
We’re now at 395 suspected cases and 106 deaths. But there have been no new numbers from DRC for how many of those are confirmed (it was 8 on Friday).
One crucial piece of information in the next days will be how many of the samples from suspected cases turn out to be positive for Ebola virus.
Show threadKai KupferschmidtMay 19
INDEX CASE:
Related to how big the outbreak is, is the question of when it started.
The earliest case for now is a nurse that fell ill on April 24 and died three days later. But I don’t think anyone really believes that a nurse happened to be the first case, presumably she treated a sick patient.
Show threadKai KupferschmidtMay 19
So an investigation into this early history of the outbreak could also help figure out not just how and where it started but how much time it has gone under the radar.
That’s another thing I’m hoping to hear more about in the coming days.
Show threadKai KupferschmidtMay 19
DIAGNOSIS:
One reason that the outbreak had so much time to grow is the fact that there is less ability to diagnose this rare species of Ebola virus called Bundibugyo.
It was discovered when it caused an outbreak in Uganda in 2007 and has caused only one other outbreak, 2012 in DRC.
Show threadKai KupferschmidtMay 19
The lab in Bunia (and many other labs) used a GeneXpert machine for diagnoses and that only recognizes Ebola Zaire, the most common species. There are no cartridges for this machine to detect Ebola Bundibugyo. I’ve been told that efforts are under way to change that asap.
Show threadKai Kupferschmidt
At least for now, a different point-of-care testing kit from Radione that detects all Ebola species is being used, Placide Mbala told me. But: “We are still waiting for more RadiOne reagents to deploy to all remote labs close to where suspected cases are being reported.”
May 19 at 11:29amWeb
Show threadKai KupferschmidtMay 19
GENOMES:
Lack of reagents hampered sequencing too, but we still got a sequence from Uganda on Sunday and two from DRC on Monday.
We’re all getting used to this and expect it now, but it still amazes me and as Kristian Andersen told me “Amazing work from those two teams—bloody fast turnaround!”
Show threadKai KupferschmidtMay 19
In the phylogenetic trees (essentially family trees of viruses) the new sequences look to be pretty much in the middle between those from the 2007 and the 2012 outbreak, Andrew Rambaut told me. “It looks exactly what I would expect a new spillover from the reservoir in the area would look like.”
Show threadKai KupferschmidtMay 19
SPREAD:
Given how big this outbreak seems to be and that cases have already been picked up in Uganda and in Goma, it seems all but certain that people infected with Ebola have travelled elsewhere too and as testing and awareness ramps up Ebola cases are likely to be identified elsewhere.
Show threadKai KupferschmidtMay 19
Salim Abdool Karim told me: “I’m anticipating before the end of the week we're going to get cases in other places.”
Honestly, at this point I would feel better if such cases do appear soon, because if they don’t I’d be very worried that we are just not detecting them.
Show threadKai KupferschmidtMay 19
One last thing: I wanna be clear what I worry about most when I say "spread".
A patient ending up in a hospital in Kigali, Johannesburg or Berlin is not the issue. But sick people in low-ressource settings traveling home to loved ones who will care for them, taking the virus into a new community, where it can then spread.
Show threadKai KupferschmidtMay 19
So much more to say on trust and community and candidate vaccines and drugs etc. But will leave that for another time.
Read and share the story if you want to help good information spread (and help pay for my reporting):
https://www.science.org/content/article/scientists-play-catch-startling-ebola-outbreak