Ebola case confirmed in Congolese city of Goma, home to over 2 million

LONDON -- The Ebola outbreak in the Democratic Republic of the Congo has spread to the city of Goma, a major transportation hub along the Rwandan border that's home to more than two million people.

The confirmed Ebola case in Goma was announced late Sunday by the Democratic Republic of the Congo's health ministry. The patient, a 46-year-old pastor from South Kivu province, was admitted to an Ebola treatment center in Goma, but then transferred to one in Butembo on Monday morning, according to a statement from the health ministry.

It's the first Ebola case to be confirmed in Goma since the ongoing outbreak began nearly a year ago. The city, located on the nation's eastern border with Rwanda, is the bustling capital of North Kivu province, one of the two affected provinces in the epidemic. It receives a large number of travelers from across the country and the greater region.

The World Health Organization, the global health arm of the United Nations, has decided three times not to declare the current outbreak a public health emergency of international concern, which would mobilize more resources and command global attention.

However, the WHO's director-general, Dr. Tedros Adhanom Ghebreyesus, said the identification of a confirmed case in Goma "could potentially be a game-changer in the epidemic" and he would reconvene the emergency committee as soon as possible to reassess the situation.

"Just when we start to get control of the virus in one area, it appears in another," Ghebreyesus said at a press conference Monday at the United Nations office in Geneva.

The pastor traveled from Bukavu, the capital of South Kivu province, to Butembo, a city in North Kivu province, on July 4 for an evangelical mission, passing through Goma on the way. While in Butembo, which is a major hot spot in the Ebola outbreak, the pastor delivered sermons at seven churches where he laid his hands on worshipers, including those who were sick, according to the country's health ministry.

The pastor began showing signs of illness on July 9 when he was still in Butembo. He was cared for by a nurse until he left by bus for Goma on Friday. The bus went through three health checkpoints en route to Goma, during which the pastor did not appear to show symptoms of Ebola. He gave different names at each checkpoint, possibly "indicating his desire to hide his identity and state of health," the health ministry said in a statement.

Upon arriving in Goma on Sunday morning, the pastor checked into a health center, feeling ill with a fever. No other patients were in the health center at the time, according to the health ministry.

The health center staff recognized the symptoms of Ebola and immediately alerted the response teams in Goma, who transferred the pastor to the city's Ebola treatment center. A laboratory test came back positive Sunday afternoon, according to the health ministry.

The bus driver and the 18 other passengers on board have been identified and will begin vaccinations Monday.

"It is important that people keep calm," the country's health minister, Dr. Oly Ilunga Kalenga, said in a statement Sunday night. "Due to the speed with which the patient has been identified and isolated, as well as the identification of all bus passengers coming from Butembo, the risk of spreading into the rest of the city of Goma remains low. However, caution remains."

Although officials expressed alarm at the confirmation of Ebola in Goma, the Congolese health ministry and the WHO said they have been preparing for this for months. Since November, more than 3,000 health workers in Goma have been vaccinated for Ebola and trained in the detection and management of Ebola patients. The Ebola treatment center in Goma has been up and running since February, health officials said.

A total of 2,489 people have reported symptoms of hemorrhagic fever in the Democratic Republic of the Congo's northeastern provinces of North Kivu and Ituri since Aug. 1, 2018. Among those cases, 2,395 have tested positive for Ebola virus disease, which causes an often-fatal type of hemorrhagic fever, according to the latest bulletin from the country's health ministry.

The current outbreak has a case fatality rate of about 67%. There have been 1,665 deaths so far, including 1,571 people who died from confirmed cases of Ebola. The other deaths are from probable cases, according to the health ministry.

Two people, including a 5-year-old boy, who tested positive for Ebola after traveling home to neighboring Uganda have also died, according to the Ugandan health ministry. The boy was the first cross-border case in the ongoing outbreak.

Since Aug. 8, more than 161,400 people have been vaccinated against Ebola in the outbreak zone in the Democratic Republic of the Congo, using an experimental vaccine developed by American pharmaceutical company Merck.

This is the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo and the most severe seen in the Central African nation since 1976, when scientists first identified the virus near the eponymous Ebola River. It's also one of the worst outbreaks ever, second only to the 2014-2016 epidemic in multiple West African countries that infected 28,652 people and killed 11,325, according to data from the U.S. Centers for Disease Control and Prevention.

At Monday's press conference, the WHO's director-general described the current outbreak as "even more complicated" than the West African epidemic, due to the region's violence and insecurity, sporadic attacks on health workers, a highly mobile population, political instability, community mistrust and misinformation.

"All of these challenges make this outbreak one of the most complex humanitarian emergencies any of us have ever faced," Ghebreyesus told reporters, noting that the risk of spread within the country and in the region remains "very high."

It's the first Ebola outbreak in history to occur in an active war zone. The WHO has recorded at least 198 attacks on health facilities and health workers in the region since January.

"We are dealing with one of the world's most dangerous viruses in the one of the world's most dangerous areas," Ghebreyesus said. "Every attack sets us back."
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