A team from Doctors Without Borders dons
protective clothing and equipment as they
prepare to treat Ebola patients in an isolation
ward of Mbandaka hospital in Congo. (Louise
Annaud/Doctors Without Borders/AP)

the country's deadly Ebola outbreak
— which has already spread to an urban area
— before the situation gets any worse. But
controlling the virus may have just gotten
tougher.
On Thursday, a senior Doctors Without
Borders aid worker said that two patients
infected with Ebola who fled their
hospital on Monday night potentially
exposed dozens of more people to the virus.
In a briefing in Geneva, Jean-Clement Cabrol,
a doctor who had just returned from Congo,
said "the patients were in the active phase of
the disease, vomiting" when their families
removed them from the hospital, put them
on motorcycles, and took them to a religious
gathering of 50 people. Ebola is contagious
through bodily fluids, and both patients, who
were at an acute phase of the illness, died
within hours.

two were among the three Ebola
patients who left a hospital isolation ward
and reentered the general population,
according to the Doctors Without
Borders mission in the Congolese city of
Mbandaka.
One patient left Sunday, shortly before being
discharged, and is still alive, according to the
aid group. The two others who attended the
prayer gathering left overnight Monday; one
died outside of quarantine, and another was
brought back to the hospital and died there.
“In all three cases, every effort was made by
staff at the hospital to convince the patients
— and their families — not to leave and to
continue their treatment,” Brienne Prusak, a
press officer for MSF, as Doctors Without
Borders is frequently known, said in a
statement.
“It is unfortunate but not unexpected,” said
WHO spokesman Tarik Jasarevic. “It is
normal for people to want the loved ones to
be at home during what could be the last
moments of life.”
Now comes the challenge of determining who
the patients may have come into contact with
once they left the hospital in the city of more
than 1 million people. There have been 58
confirmed, probable and suspected cases of
Ebola — and 27 deaths — as of Tuesday. That
number could dramatically increase if the
disease were to spread widely in a major city.
Knowing who has been exposed to Ebola is
also critical to the effectiveness of the new
Ebola vaccine that has been deployed to
Congo. Proper use of the vaccine relies on
identifying every person who may have come
into contact with an infected individual, then
working outward from there in what experts
call “rings” of people, which includes
contacts of contacts.
The idea is to quickly immunize those at
highest risk of contracting the virus before
they could potentially become infected and
spread it themselves. As of this week, the
WHO said 628 such contacts had been listed
in Congo.
When Ebola hit West Africa in 2014, some of
the obstacles that impeded the medical
response included lack of trust among
communities dealing with outbreaks and
religious practices — such as washing the
body of the dead — that spread the disease,
which is contagious through bodily fluids.
Community outreach to religious leaders in
particular helped familiarize communities
with the proper safety protocols.
But lack of trust between patients and
doctors is often the reason those sick with
Ebola would attempt to evade treatment,
which can be intimidating when it involves
isolating them from their families and only
interacting with medical professionals
dressed in hazmat suits. In previous Ebola
outbreaks, patients have also left the
hospital despite doctors urging them not to.
MSF is warning against seeing “forced
hospitalization” as the solution to the
outbreak.
“Patient adherence is paramount,” Prusak
said. “The quicker patients are admitted, the
greater their chance of survival and the
greater the chance of limiting the spread of
Ebola.”


https://www.washingtonpost.com/news/worldviews/wp/2018/05/23/three-ebola-patients-fled-quarantine-in-congo-sparking-fears-that-the-disease-may-spread/?utm_term=.58784def8460