recommendations for the covid 19 response at the national level based on lessons learned CORD-Papers-2022-06-02 (Version 1)

Title: Recommendations for the COVID-19 Response at the National Level Based on Lessons Learned from the Ebola Virus Disease Outbreak in the Democratic Republic of the Congo
Abstract: The tenth outbreak of Ebola virus disease (EVD) in North Kivu the Democratic Republic of the Congo (DRC) was declared 8 days after the end of the ninth EVD outbreak in the Equateur Province on August 1 2018. With a total of 3461 confirmed and probable cases the North Kivu outbreak was the second largest outbreak after that in West Africa in 20142016 and the largest observed in the DRC. This outbreak was difficult to control because of multiple challenges including armed conflict population displacement movement of contacts community mistrust and high population density. It took more than 21 months to control the outbreak with critical innovations and systems put into place. We describe systems that were put into place during the EVD response in the DRC that can be leveraged for the response to the current COVID-19 global pandemic.
Published: 2020-05-19
Journal: Am J Trop Med Hyg
DOI: 10.4269/ajtmh.20-0256
DOI_URL: http://doi.org/10.4269/ajtmh.20-0256
Author Name: Mobula Linda Meta
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mobula_linda_meta
Author Name: Samaha Hadia
Author link: https://covid19-data.nist.gov/pid/rest/local/author/samaha_hadia
Author Name: Yao Michel
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yao_michel
Author Name: Gueye Abdou Salam
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gueye_abdou_salam
Author Name: Diallo Boubacar
Author link: https://covid19-data.nist.gov/pid/rest/local/author/diallo_boubacar
Author Name: Umutoni Chantal
Author link: https://covid19-data.nist.gov/pid/rest/local/author/umutoni_chantal
Author Name: Anoko Julienne
Author link: https://covid19-data.nist.gov/pid/rest/local/author/anoko_julienne
Author Name: Lokonga Jean Pierre
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lokonga_jean_pierre
Author Name: Minikulu Luigi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/minikulu_luigi
Author Name: Mossoko Mathias
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mossoko_mathias
Author Name: Bruni Emanuele
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bruni_emanuele
Author Name: Carter Simone
Author link: https://covid19-data.nist.gov/pid/rest/local/author/carter_simone
Author Name: Jombart Thibaut
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jombart_thibaut
Author Name: Fall Ibrahima Soce
Author link: https://covid19-data.nist.gov/pid/rest/local/author/fall_ibrahima_soce
Author Name: Ahuka Mundeke Steve
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ahuka_mundeke_steve
sha: 317054f7e67b1f015ec7cf62d72827345fa07708
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32431285
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32431285
pmcid: PMC7356463
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356463
url: https://doi.org/10.4269/ajtmh.20-0256 https://www.ncbi.nlm.nih.gov/pubmed/32431285/
has_full_text: TRUE
Keywords Extracted from Text Content: DRC EVD COVID-19 Ebola virus IPC COVID-19 donors coronavirus EVD patients Red Cross (see Table 1 LEARNED Multi-sectoral Lingala DRC 10th EVD OUTBREAK multi-sectorial Food measles SARS-CoV-2. Ebola virus Hubei Province Congo mobilizers Goma cell Wuhan DRC volunteers UNICEF health zones funds EVD COVID-19
Extracted Text Content in Record: First 5000 Characters:The tenth outbreak of Ebola virus disease (EVD) in North Kivu, the Democratic Republic of the Congo (DRC), was declared 8 days after the end of the ninth EVD outbreak, in the Equateur Province on August 1, 2018. With a total of 3,461 confirmed and probable cases, the North Kivu outbreak was the second largest outbreak after that in West Africa in 2014-2016, and the largest observed in the DRC. This outbreak was difficult to control because of multiple challenges, including armed conflict, population displacement, movement of contacts, community mistrust, and high population density. It took more than 21 months to control the outbreak, with critical innovations and systems put into place. We describe systems that were put into place during the EVD response in the DRC that can be leveraged for the response to the current COVID-19 global pandemic. On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its tenth outbreak of Ebola virus disease (EVD) in North Kivu. This outbreak was declared 8 days after the end of the ninth EVD outbreak in the Equateur Province, with a total of 54 confirmed and probable cases. 1 With a total of 3,453 confirmed and probable cases, the North Kivu outbreak remains the second largest EVD outbreak, after the West Africa outbreak in 2014-2016. 2 Several security incidents, including attacks by armed groups, hindered implementation of activities by causing a reduced operational presence, rendered certain health zones inaccessible, and likely led to increased transmission. 3, 4 Since January 2019, more than 350 incidents that disrupted response activities were recorded, 80% of which were directly targeted at structures or response personnel. 4 Population displacement, conflict, a highly dense population, mistrust, and insufficient aid for basic services impacted response activities. The EVD response was government led with the support of a number of technical and strategic partners such as the WHO, UNICEF, the World Food Program, the International Organization of Migration (IOM), the U.S. CDC, the UN Office for the Coordination of Humanitarian Affairs, and a number of nongovernmental organizations. Donors worked in concerted and harmonized ways to support the response. The response was driven by a unique National Ebola Strategic Response Plan with a unique budget. The public health response was coordinated by the Multi-sectoral Technical Secretariat and the Ministry of Health. Core pillars of the response were coled by the government and technical partners such as the WHO, UNICEF, the IOM, and the International Federation of the Red Cross (see Table 1 ). The main strategic objective of the EVD response was to break chains of transmission, by ensuring rapid detection and isolation of cases, intensification of multidisciplinary public health measures around a confirmed case, strengthening of community engagement activities, strengthening of health systems, and effective coordination of both local and international partners. On December 31, 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan city, Hubei Province. By January 7, 2020, Chinese scientists isolated a novel coronavirus. 5 The COVID-19 outbreak was declared a public health emergency of international concern on January 30, 2020. On March 11, the WHO declared a global pandemic of COVID-19 as a result of the spread of SARS-CoV-2. 6 LESSONS LEARNED FROM THE DRC 10th EVD OUTBREAK Although modes of transmission and strategies to "flatten the curve" differ between EVD and COVID-19, there are broad lessons learned from the EVD response that can generally be applied to the COVID-19 response. An effective COVID-19 response focuses on rapid detection via testing, contact tracing, isolation, treatment, and mitigation measures including physical distancing. We describe critical systems that were put into place during the tenth EVD response in the DRC that we believe can be leveraged for the response to the current COVID-19 pandemic ( Table 2) . Coordination. Coordination of international and national counterparts during a public health emergency is critical, with an accountability system and clear understanding of who is in charge. Coordination for the EVD response was under the leadership of the MOH and Technical Secretariat, a multisectoral body put into place by the presidency. Clear roles for the coleads (United Nations and other international organizations) were established. Command and control of operations was centralized in Goma, with decentralized sub-coordination at the health zone level. The lack of standardized data on the implementation of operations during the West African EVD outbreak led to the creation of a monitoring framework. This provided operational and strategic analyses to enable partners and donors to follow-up on response outcomes. The monitoring framework in the DRC represented one of the first attempts to use a harmonized, multisectorial, and
Keywords Extracted from PMC Text: Congo contacts cell multi-sectorial measles low- UNICEF transmission.3,4 Red Cross (see Table 1 Donors Hubei Province COVID-19 EVD patients Ebola virus funds donors Wuhan health zones Goma Food IPC mobilizers EVD personnel.4 DRC Multi-sectoral Lingala cases.1 volunteers
Extracted PMC Text Content in Record: First 5000 Characters:On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its tenth outbreak of Ebola virus disease (EVD) in North Kivu. This outbreak was declared 8 days after the end of the ninth EVD outbreak in the Equateur Province, with a total of 54 confirmed and probable cases.1 With a total of 3,453 confirmed and probable cases, the North Kivu outbreak remains the second largest EVD outbreak, after the West Africa outbreak in 2014–2016.2 Several security incidents, including attacks by armed groups, hindered implementation of activities by causing a reduced operational presence, rendered certain health zones inaccessible, and likely led to increased transmission.3,4 Since January 2019, more than 350 incidents that disrupted response activities were recorded, 80% of which were directly targeted at structures or response personnel.4 Population displacement, conflict, a highly dense population, mistrust, and insufficient aid for basic services impacted response activities. The EVD response was government led with the support of a number of technical and strategic partners such as the WHO, UNICEF, the World Food Program, the International Organization of Migration (IOM), the U.S. CDC, the UN Office for the Coordination of Humanitarian Affairs, and a number of nongovernmental organizations. Donors worked in concerted and harmonized ways to support the response. The response was driven by a unique National Ebola Strategic Response Plan with a unique budget. The public health response was coordinated by the Multi-sectoral Technical Secretariat and the Ministry of Health. Core pillars of the response were coled by the government and technical partners such as the WHO, UNICEF, the IOM, and the International Federation of the Red Cross (see Table 1). The main strategic objective of the EVD response was to break chains of transmission, by ensuring rapid detection and isolation of cases, intensification of multidisciplinary public health measures around a confirmed case, strengthening of community engagement activities, strengthening of health systems, and effective coordination of both local and international partners. On December 31, 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan city, Hubei Province. By January 7, 2020, Chinese scientists isolated a novel coronavirus.5 The COVID-19 outbreak was declared a public health emergency of international concern on January 30, 2020. On March 11, the WHO declared a global pandemic of COVID-19 as a result of the spread of SARS-CoV-2.6 Coordination of international and national counterparts during a public health emergency is critical, with an accountability system and clear understanding of who is in charge. Coordination for the EVD response was under the leadership of the MOH and Technical Secretariat, a multisectoral body put into place by the presidency. Clear roles for the coleads (United Nations and other international organizations) were established. Command and control of operations was centralized in Goma, with decentralized sub-coordination at the health zone level. The lack of standardized data on the implementation of operations during the West African EVD outbreak led to the creation of a monitoring framework. This provided operational and strategic analyses to enable partners and donors to follow-up on response outcomes. The monitoring framework in the DRC represented one of the first attempts to use a harmonized, multisectorial, and real-time monitoring system that maintained situational awareness to evaluate short- and medium-term impacts of activities.7 The Technical Secretariat adopted an incident management system, whose aim was to improve information flow and decentralize decision-making. It created clear roles and responsibilities to ensure improved span of control and chain of command, which was necessary because of the lack of prompt decision-making at the coordination level. For COVID-19, national governments should consider using an incident management system to support coordination of the response at the national level. This will allow for decentralized and prompt decision-making on operations and provision of technical guidance. Under the leadership of the government, strategic meetings should be held regularly, with lead agencies involved in the operationalization and technical leadership of the response. Countries should consider adopting a monitoring framework that looks at performance indicators to guide the implementation of multi-sectorial operations in real time. Public health performance indicators at the beginning of the EVD response were poor, with increasing community deaths, poor contact tracing (indicated by the high number of cases that had no known contacts), and delays between symptom onset and isolation. A decline in cases toward the end of 2019 was thought to be due to improvement in the quality of surveillance activities, including prompt investigation, early detectio
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