The outbreak of Ebola virus disease in 2022: A spotlight on a re-emerging global health menace

Ebola virus disease (EVD) is a rare but highly contagious and lethal disease that occurs predominantly in African countries, with a case-fatality rate of 30–90%. The causative viral pathogens of EVD are within the genus Ebolavirus in the family Filoviridae. The primary route of human-to-human transmission is through direct contact with blood, bodily fluids and secretions from infected individuals. Direct contact with virally contaminated objects and sexual transmission have also been reported. Management of EVD is aggressive supportive care with possibly new therapeutic options. On 20 September 2022, an EVD outbreak was declared in Uganda, caused by Sudan ebolavirus. As of 7 November 2022, a total of 136 confirmed cases, 53 confirmed deaths have been reported, including 18 cases with seven deaths among healthcare workers. In the Democratic Republic of Congo (DRC), an EVD outbreak was also declared on 22 August 2022 (which ended on 27 September 2022);with only one case, a middle-aged woman. At the time when most countries in the world have been occupied with the coronavirus disease 2019 (COVID-19) pandemic and the recent human monkeypox outbreak, these two outbreaks of EVD have the potential to significantly add to the burden on global health. Authorities need to augment their multi-faceted response, including stringent contact tracing and border control, to avoid the catastrophe of the 2014–2016 EVD epidemic. © 2022, School of Medicine, Universitas Syiah Kuala. All rights reserved.

COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021.

Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.

Points of entry dynamics: understanding the cross-border threats for Ebola virus disease and COVID-19 in Ghana using a logic model approach.

Background: The influx of people across the national borders of Ghana has been of interest and concern in the public health and national security community in recent times due to the low capacity for the prevention and management of epidemics and other public health risks. Although the international health regulations (IHR) stipulate core public health capacities for designated border facilities such as international airports, seaports, and ground crossings, contextual factors that influence the attainment of effective public health measures and response capabilities remain understudied. Objective: This study aims to assess the relationship between contextual factors and COVID-19 procurement to help strengthen infrastructure resources for points of entry (PoE) public health surveillance functions, thereby eliminating gaps in the design, implementation, monitoring, and evaluation of pandemic-related interventions in Ghana. Methods: This study employed a mixed-methods design, where quantitative variables were examined for relationships and effect size interactions using multiple linear regression techniques and the wild bootstrap technique. Country-level data was sourced from multiple publicly available sources using the social-ecological framework, logic model, and IHR capacity monitoring framework. The qualitative portion included triangulation with an expert panel to determine areas of convergence and divergence. Results: The most general findings were that laboratory capacity and Kotoka International Airport testing center positively predicted COVID-19 procurement, and public health response and airline boarding rule negatively predicted COVID-19 procurement. Conclusion: Contextual understanding of the COVID-19 pandemic and Ebola epidemic is vital for strengthening PoE mitigation measures and preventing disease importation.

COVID-19 and culture

The USA has been particularly hard hit by the COVID-19 pandemic and a wide spatial variation can be seen in its spread and mortality. This raises the question of why some regions are more resilient to the pandemic than others? We hypothesize that the individualism-collectivism cleavage explains the disparity in COVID-19 cases observed across sub-national units in the USA. Cultural disparity among different groups of people leads to differences in how they perceive health crises and thereby shapes the way they respond to pandemics. A heightened sense of obligation and responsibility increases in-group sociability and interdependence and raises the perceived vulnerability towards disease transmission among collectivistic individuals, and this leads to greater adherence to containment measures and social distancing rules. Our results provide evidence that more individualistic states tend to have more COVID-19 cases across the USA.

The lasting influence of Ebola: a qualitative study of community-level behaviors, trust, and perceptions three years after the 2014-16 Ebola epidemic in Liberia.

The majority of disease transmission during the 2014-16 West Africa Ebola epidemic was driven by community-based behaviors that proved difficult to change in a social paradigm of misinformation, denial, and deep-seated distrust of government representatives and institutions. In Liberia, perceptions and beliefs about Ebola during and since the epidemic can provide insights useful to public health strategies aimed at improving community preparedness. In this 2018 study, we conducted nine focus groups with Liberians from three communities who experienced Ebola differently, to evaluate behaviors, attitudes, and trust during and after the epidemic. Focus group participants reported that some behaviors adopted during Ebola have persisted (e.g. handwashing and caretaking practices), while others have reverted (e.g. physical proximity and funeral customs); and reported ongoing distrust of the government and denial of the Ebola epidemic. These findings suggest that a lack of trust in the biomedical paradigm and government health institutions persists in Liberia. Future public health information campaigns may benefit from community engagement addressed at understanding beliefs and sources of trust and mistrust in the community to effect behavior change and improve community-level epidemic preparedness.

COVID-19 and Ebola virus disease outbreaks in the Democratic Republic of Congo: adolescents and young people's sexual and reproductive health during public health emergency response

The Democratic Republic of the Congo (DRC) is facing major public health challenges due to series of outbreaks, notably the Ebola Virus disease (EVD). Like other countries of the world, the DRC is also challenged by the new coronavirus pandemic. The confluence of these major outbreaks of the Ebola virus disease and coronavirus disease 2019 (COVID-19) has affected many interventions within the healthcare sector, consequently challenging the social and economic wellbeing of the people. In the past two and half decades, the DRC has made promising progress in adolescents and young peoples' sexual and reproductive health and rights, although they are limited and uneven. Like other African countries, the government of DRC has instituted measures to respond to these outbreaks, which have led to a shift of priorities in addressing the health challenges. The government diverted resources from their intended needs to curb or control the cases of Ebola virus disease and the COVID-19 pandemic, and this has affected the availability, accessibility and affordability of sexual and reproductive health care services for adolescents and young people. As the DRC decides how best to control the COVID-19 and EVD, it is important to reflect on lessons learned from past outbreaks. The DRC Government and other stakeholders must prioritize adolescents and young people' sexual and reproductive health needs by maintaining the provision and strengthening supply chains of reproductive health information and services during COVID-19 pandemic and EVD epidemic. This commentary provides the rationale and makes a call for greater investment and prioritization of sexual and reproductive health (SRH) needs of adolescents and young people during public health emergencies preparedness and response efforts. © Simon Binezero Mambo et al.

Verifiable Surface Disinfection Using Ultraviolet Light with a Mobile Manipulation Robot †

Robots are being increasingly used in the fight against highly-infectious diseases such as the Novel Coronavirus (SARS-CoV-2). By using robots in place of human health care workers in disinfection tasks, we can reduce the exposure of these workers to the virus and, as a result, often dramatically reduce their risk of infection. Since healthcare workers are often disproportionately affected by large-scale infectious disease outbreaks, this risk reduction can profoundly affect our ability to fight these outbreaks. Many robots currently available for disinfection, however, are little more than mobile platforms for ultraviolet lights, do not allow fine-grained control over how the disinfection is performed, and do not allow verification that it was done as the human supervisor intended. In this paper, we present a semi-autonomous system, originally designed for the disinfection of surfaces in the context of Ebola Virus Disease (EVD) that allows a human supervisor to direct an autonomous robot to disinfect contaminated surfaces to a desired level, and to subsequently verify that this disinfection has taken place. We describe the overall system, the user interface, how our calibration and modeling allows for reliable disinfection, and offer directions for future work to address open space disinfection tasks. © 2022 by the authors.

Pandemics and Management of "Dangerous Communities”: Ebola, COVID-19, and Africans in China

How do we unpack and make sense of anti-African/Black sentiments in the pandemic control and mitigation practices in China? This article responds to the question by drawing a parallel between the experiences of Africans in China during the Ebola virus disease and COVID-19 outbreaks. Focusing specifically on Nigerians as a subsection of the African community in Guangzhou City, China, it explores how the COVID-19-inspired discrimination against Africans reflects much of the experiences of Africans in China during the Ebola crisis of 2014. The article combines sixteen "Ebola experience” data points, obtained from Nigerians in Guangzhou in 2017, with four COVID-19 experience virtual interviews, media reports, and social media archive and netnographic analysis covering April to June 2020. The experiences of Africans in Guangzhou in the early months of the COVID-19 outbreak reflect a patterned response to Africans and Blackness in the context of pandemic in China. The article contributes to the literature by examining the question of racial discrimination and the construction of African immigrant community in China as dangerous within the new geography of Afro-mobilities in East Asia. © 2022 by American Association of Geographers.

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo.

BACKGROUND: From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT: Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS: Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

Lessons Learned from the Ebola Virus Disease and COVID-19 Preparedness to Respond to the Human Monkeypox Virus Outbreak in Low- and Middle-Income Countries.

Recently, the World Health Organization (WHO) declared the human monkeypox virus disease an international health emergency. In the past decades, infectious disease epidemics have significantly impacted low- and middle-income countries (LMICs), with coronavirus disease-2019 (COVID-19) being the most recent. LMICs, particularly in Africa and Asia, responded reasonably well by strengthening health systems, including infection prevention and control strategies, laboratory systems, risk communication, and training of essential healthcare workers for surge capacity in preparation for and response to COVID-19. With the possibility of other epidemics, such as the current epidemic of human Monkeypox, a consolidated global response is required. This article discusses lessons learned from previous Ebola and COVID-19 outbreaks and also provides recommendations on how these lessons can be useful to strengthen monkeypox disease outbreak preparedness and response in LMIC.

SARS-CoV-2 in Africa.

The earliest cases of COVID-19 disease in Africa were, in most cases, the result of imports from abroad. The Democratic republic of the Congo (DRC) identified the first case at the beginning of 2020. Two days after his return from France, the first patient was tested positively in the capital, Kinshasa. The travel restrictions and status of the state of emergency were announced on 24 March 2020. A lockdown followed. In June of the same year, 11 provinces were already affected by COVID-19 disease. The negative socio-economic impact has occurred and is similar to that in any other country. The DRC does not differ from other African countries or on the issue of infectious diseases such as HIV, malaria, cholera, measles or Ebola virus disease. Recurring Ebola epidemics are addressed by vaccination with Ervebo vaccine. Unlike Ebola, part of the population does not believe in the existence of SARS-CoV-2 and does not respect basic anti-epidemic measures. Medical capacities were very limited at the beginning of the SARS-CoV-2 epidemic, both in terms of diagnosis and testing and availability of treatment (60 ventilators to 83 million inhabitants). The situation is complicated as a result of 20 years continuing wars. Another African country, Guinea, is currently facing not only COVID-19, but also the zoonotic disease of Lassa fever, which has been detected in several patients. Copyright © 2021, Medakta s.r.o.. All rights reserved.

LASSA FEVER. PART 2. LABORATORY DIAGNOSTICS, TREATMENT, DEVELOPMENT OF MEDICATIONS.

Globalization and high-speed means of transportation contribute to the spread of infections dangerous to humans. Airborne pathogens have pandemic potential as currently shown in case of the novel coronavirus SARS-CoV-2. Natural focal Lassa fever (LF) common in West African countries, in 35 cases was registered in non-endemic geographical areas because any person infected with Lassa virus (LASV) is a long-term source of infection (up to two months). Cases of person-to-person infection in endemic territories are described. In Germany, the facts of secondary virus transmission from patients to doctors have been recorded during the examination and blood collection from an apparently healthy person as well as during the autopsy of a deceased subjects due to severe LF course. Nonspecific malaise symptoms in LF are also characteristic of numerous other diseases common on the African continent, e.g., malaria and typhoid fever or viral infections such as yellow fever, Chikungunya, dengue and Zika, monkey pox and Ebola virus disease. In this regard, there may be similar dermatological manifestations. Timely detection of cases and differential diagnosis are crucial to ensure safe patient care and use of affordable antiviral therapy for LL provided by the drug Ribavirin. Research methods for study ing LASV use polymerase chain reaction (PCR) for detecting viral RNA, electron microscopy, isolation of infectious virus cultured sensitive cells, indirect immunofluorescence reaction, enzyme immunoassay (ELISA) and immunochromatographic assays for the detection of antibodies and/or antigen as well as immunoblotting. Currently, test kits based on molecular and genetic methods are mainly used for LF laboratory diagnostics. Since the 1980s, ribavirin has been used to treat patients with LF. The serum accumulation of the drug in large quantities causes hemolysis, development of anemia and impaired renal function. In this regard, treatment options are being considered with decline in its concentration due to combined use with other antiviral drugs. A search for new therapeutic agents capable of inhibiting viral replication at disease early stage has been in progress due to lack of any approved vaccines. (English) [ FROM AUTHOR] Глобализация и скоростные средства передвижения способствуют распространению инфекций, опасных для человека. Патогены, передаваемые воздушно-капельным путем, обладают пандемическим потенциалом, как в настоящее время показано на примере нового коронавируса SARS-CoV-2. Природно-очаговая лихорадка Ласса (ЛЛ), распространенная в странах западной Африки, в 35 случаях была зарегистрирована на неэндемичных географических районах, так как человек, инфицированный вирусом Ласса (Lassa virus, LASV), является источником инфекции длительное время (до двух месяцев). На эндемичных территориях описаны случаи заражения при передаче вируса «от человека к человеку». В Германии зафиксированы факты вторичной передачи вируса от пациентов врачам при осмотре и взятии крови у внешне здорового человека, а также при вскрытии погибшего в результате тяжелого течения ЛЛ. Неспецифические симптомы недомогания при ЛЛ характерны и для других многочисленных заболеваний, распространенных на африканском континенте, например, при малярии и брюшном тифе или при вирусных инфекциях - это желтая лихорадка, лихорадки Чикунгунья, денге и Зика, оспа обезьян и болезнь, вызванная вирусом Эбола. При протекании этих болезней могут быть и схожие дерматологические проявления. Своевременное выявление заболевших и дифференциальная диагностика имеют решающее значение для обеспечения безопасного ухода за пациентами и применения доступной противовирусной терапии (при ЛЛ это препарат рибавирин). Методы научных исследований LASV включают: анализы на основе полимеразной цепной реакции (ПЦР) по определению вирусной РНК, электронную микроскопию, выделение инфекционного вируса на культуре чувствительных клеток, реакцию непрямой иммунофлуоресценции (РНИФ), иммуноферментный (ИФА) и иммунохроматографический (ИХА) анализы по выявлению антител и/или антигена, а также иммуноблоттинг. Для диагностики ЛЛ в настоящее время, в основном, используют тест-системы на основе молекулярно-генетических методов. С 80-х гг. XX в. и до сих пор для лечения пациентов с ЛЛ используют рибавирин, но накопление этого препарата в плазме в больших количествах вызывает гемолиз, развитие анемии и нарушение функции почек. В связи с этим рассматриваются варианты лечения при уменьшении его концентрации за счет сочетанного использования с другими противовирусными препаратами. Идет поиск новых терапевтических средств, способных ингибировать вирусную репликацию на ранней стадии болезни, так как зарегистрированные вакцины отсутствуют. (Russian) [ FROM AUTHOR] Copyright of Russian Journal of Infection & Immunity is the property of National Electronic-Information Consortium and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Interactions Among Cross-Border Contiguous Communities and Implications for Managing Pandemics - The case of Ghana and Burkina Faso During the Ebola Outbreak in West Africa: A Qualitative Study.

Introduction: In sub-Saharan Africa, extensive migratory activities and interactions exist especially amongst unmanned cross-border communities between countries sharing common borders which complicate emergency public health interventions. Understanding the nature of these activities and interactions will help strengthen public health interventions and control of pandemics such as the Ebola outbreak and COVID-19. Objective: The study aimed to understand the nature of contiguous border communities' interactions and to seek community solutions for building efficient and resilient health systems to combat a possible Ebola outbreak in Ghana and Burkina Faso and the control of future pandemics. Methods: A qualitative cross sectional study design using focused group discussions and key informant interviews involving six focused groups and forty-six key informants were conducted amongst six Kasem-speaking contiguous border communities, three-each in Ghana and Burkina Faso. Findings: Findings of interactions consisted of social interactions such as marriage ceremonies; traditional and religious practices; informal trade; and health seeking behavior in the study communities. Collaborative disease surveillance systems; constructive dialogue involving community traditional leaders; incorporation of health education into social, traditional and religious activities; retraining of health personnel; effective communication including networking; and inter-governmental collaborations were identified as solutions to the effective control of the Ebola outbreak and for future public health interventions in general. Conclusion: Understanding community interactions and seeking community solutions were identified to be crucial in building efficient health systems that are resilient and responsive to the Ebola outbreak and for future pandemics in contiguous border communities in sub-Saharan Africa.

Futurology and monitoring in the field of virology to deal with emerging diseases

Every year we see many changes in the world around us. One of these changes is the climate and weather, and it could be one of the reasons for changing behaviors between humans and animals, which could cause zoonotic diseases. We usually face new diseases that infect a growing population leading to a pandemic. Different reasons are leading to an increase in the emergence of new infections. Some of these diseases can be associated with zoonotic diseases and the diverse world of viral genetics and its failures. Furthermore, properties like mutations and also unknown effects of these mutations on the virulence of the agents make it challenging to trace new diseases. As we know, preventing emerging diseases is inevitable and viral diseases are dangerous, and some viruses can spread quickly and cause an endemic or pandemic. As was noticed during the recent pandemic, the need to study emerging diseases in the field of virology has become more and more apparent to us. In this review, we want to look at how we could monitor and control these diseases with new approaches and what should be done when a disease emerges. Moreover, we will investigate risk factors, ways to deal with emerging viral infections, new treatments that make the condition better when a person gets infected, and the future of these diseases. We will also study the ways to deal with pandemics with the new generations of vaccines.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo.

BACKGROUND: Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo. METHODS: Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes. RESULTS: Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distressT1= 57.04%, Mental distressT2= 40.29%, x2= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001). CONCLUSIONS: Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo.

Ebola virus disease (EVD) survivors and healthcare workers (HCWs) face stress, fear, and stigma during the COVID-19 pandemic that can induce severe symptoms of anxiety and post-traumatic stress disorder (PTSD). We examined the prevalence and factors related to severe PTSD and anxiety symptoms, using a representative sample of survivors of the 2018-2020 EVD epidemic in DR Congo in comparison HCWs. Five hundred sixty-three participants (55.25% women, 309 survivors, 202 HCWs, and 52 HCWs and survivors) completed questionnaires assessing anxiety, PTSD, exposure to EVD and COVID-19, stigmatization related to EVD and COVID-19, interpersonal traumas, social support. During the COVID-19 pandemic, 45.6 and 75.0% of survivors and HCWs reported severe symptoms of PTSD and anxiety. Significant difference was observed among the three groups for both PTSD (53.7% survivors, 37.1% HCWs, and 30.8% HCWs-survivors, χ2= 18.67, p < 0.0001) and anxiety (88.3% survivors, 56.9% HCWs, and 65.4% HCWs- survivors, χ2= 67.03, p < 0.0001). Comorbidity of severe PTSD and anxiety symptoms was 42.3% between the three groups. Results revealed that exposure to EVD (b = 0.53; p = 0.001; b = 0.12; p = 0.042), EVD-related stigmatization (b = 0.14; p = 0.018; b = 0.07; p = 0.006), COVID-19-related stigmatization (b = 0.22; p < 0.0001; b = 0.08; p = 0.0001) and social support (b = -0.30; p < 0.0001; b = -0.14; p < 0.0001) predicted severe PTSD and anxiety symptoms. The last models explained 63.8 and 56.4% of the variance of PTSD and anxiety. Symptoms of PTSD and anxiety are common among EVD survivors and HCWs during the COVID-19 pandemic. Culturally-sensitive programs that address stigma are necessary to mitigate the cumulative effects of EVD and the COVID-19 pandemic on EVD survivors and HCWs.

Keeping Ebola at bay: public authority and ceremonial competence in rural Sierra Leone

Ebola Virus Disease struck Sierra Leone in May 2014. An international response was instrumental in ending the epidemic by December 2015 and has been extensively documented. Less attention has been paid to local responses. Here, we focus on a case in which there was no infection despite high infection in neighbouring areas. This brings into focus the role of customary public authority in implementing successful controls. We pay particular attention to the activities of a chiefdom Ebola Task force committee chaired by the Paramount Chief. Meetings were characterised by protocol and ceremony, but ‘face time’ served to reinforce, in ritual terms, important messages about quarantine and social distancing. The committee's pronouncements had illocutionary force. Local volunteers translated this ceremonial message into practical action to block imported cases. The analysis of ceremonial competence, we conclude, opens a window into how public authority addresses developmental shocks in Africa.