Thread by @HelenBranswell

1. @WHO has issued an update on the #Marburg outbreak in Equatorial Guinea. It is not reassuring. A 🧵
Before getting into it, a note on the Marburg outbreak in Tanzania. WHO says the case count remains at 8, with 5 deaths. If accurate, this outbreak doesn't seem to be growing.

2. Equatorial Guinea: The case count is up to 38 confirmed & probable #Marburg cases; at least 89% are dead. Authorities don't know the identify/whereabouts/disease outcome of 1 case. (shudder)
The most recent case tested positive on April 7. Not yet clear how s/he got infected.

3. There is no reason to think this outbreak is coming under control. Equatorial Guinea is lucky in that #Marburg doesn't seem to transmit as well as Ebola; Marburg outbreaks have historically been smaller. But one can't assume a Marburg outbreak will be small. See Angola 2004-05

4. @WHO's update says some concerning things. And some of the things it doesn't say are also concerning.
To wit: It appears that #Marburg treatment centers haven't been set up. That's dangerous; 4 health workers have already been infected.

5. I'm hearing the government has been slow to let in outside help. There is no mention of MSF or Alima in the @WHO update. Equatorial Guinea has never dealt with a filovirus outbreak before. Having help in safe patient care is critical.

6. #Marburg cases have been detected in at least five parts of the country, & in areas bordering Cameroon & Gabon. @WHO has characterized the risk as "very high at the national level, high at sub-regional level, moderate at the regional level and low at the global level."

7. Most of the #Marburg cases have been in Bata, a large port (pop. ~455,000) with an international airport. Filovirus outbreaks + cities = dangerous.
Some of the cases have not had clear links to previous cases, which could be a sign of undetected transmission chains.
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