WHO Situation Reports Research Articles

A Flashback to Cholera Outbreaks in Kurdistan region-Iraq

Cholera is a contagious acute diarrheal disease due to ingestion of contaminated water and food with Vibrio cholera, a Gram-negative bacterium that naturally inhabits coastal and estuarine ecosystems. Millions of cholera cases and thousands of deaths are annually reported worldwide. Cholera is endemic in Iraq with every 3-5 years interval. Meanwhile, cholera outbreaks have been reporting in Kurdistan region. However, the epidemiology of the disease has not been investigated. This study comprehensively reviewed the cholera outbreaks in Kurdistan region, depending on the WHO situation reports, online resources and scientific researches. The results showed seven reported cholera outbreaks from 1995 to 2022. The cholera epidemics happened at irregular intervals that makes the prediction of next outbreak difficult. Moreover, the trend of cholera is greatly decreasing from thousands to hundreds of cases throughout the outbreaks and in total about 30 people died. These might be the consequences of effective prevention measures, population health and natural acquired immunity against cholera. It was found that Sulaymaniyah is the most affected governorate in the region. This is probably related to the contamination of the main drinking water resource, little Zab river. Besides, the irrigation of the vegetable fields with untreated sewage could be another cause. Also, both Inaba and Ogawa serotypes of Vibrio cholera, O1, El Tor individually caused the outbreaks. Thus, cholera outbreak will be happening in Kurdistan region, particularly in Sulaymaniyah governorate. This definitely needs more scientific investigations, hoping to tackle the future outbreaks and total eradication of the disease.

The 21st century disaster: The COVID-19 epidemiology, risk factors and control

The 21st century will be indelible in the world as ruin of the outbreak of COVID-19 was arose in Wuhan, China has now spread all over the world, up to August 2020. This study was based on the factors affecting the epidemiology of this virus in human societies of global concern. We studied the articles published in journals on various aspects of nCoVID19. The Wikipedia and WHO situation reports have also been searched out for related information. Outcomes were followed up until 2020. The COVID-19 is a virus with pandemic potential which may continue to cause regular infection in human. The pandemic outbreak of COVID-19 threatened public health across the globe in form of system as reflected in the shape of emergency. Approximately 21 million humans are infected and 759,400 have lost their lives till 2020 in all over the world. We have described epidemiological features, reservoirs, transmission, incubation period, rate of fatality, management including recent clinical chemotherapeutic approach and preventive measurements and masses which are at risk of COVID19. This virus causes viral pneumonia when it attacks on respiratory system and multiple failure which can leads to life threatening complications. It is believed to be zoonotic importance although it is not clear from which animal and how it is transmitted. Zoonotic transmission of COVID-19 has not yet known by science. The current study will help to establish a baseline for early effective control of this rapidly spreading severe viral illness. The available data on COVID-19 indicates that older males with comorbidities would have been more infected, which can result in severe respiratory complications. Implementation of preventive measurements, investigation of proper chemotherapeutics and detection of cross species transmission agents must be ensured.

Natural furin inhibitor(s) as potent therapeutic molecule to mitigate SARS-CoV-2 infection

The COVID 2019 has had been going pandemic as per WHO situation reports. The major differentiating point in this virus is the presence of a unique furin cleavage site. Our insilico study points out to the effectiveness of a potent plant origin furin inhibitor. We exploited the aspect of the cleavage machinery of furin subunits which is critical and indispensible to the entry of SARS-CoV-2 in human cells and subsequent massive contagion. In-silico analysis was done to observe the interactions of proposed analogs of protease inhibitor of plant origin against furin protein as well as the furin spike glycoprotein (SGP) binding machinery. This was done by docking protocols using Hex 6.0 software followed by molecular Dynamic simulation (MDS) analysis in 100 ns scale using Amber94. Further, the images were analysed with PyMol software. The analogs I, II and III included in our study showed strong interactivity against furin individually, as well as the furin-Spike Glycoprotein 1 binding machinery. The findings were confirmed using molecular dynamic simulation analysis which indicated good structural stability and ability to neutralise furin and furin-spike glycoprotein 1. Analog II was found to be the best interactive molecule against furin, showing the least deviation (1.484 ± 0.0064). Also, it was the most effective against furin + Spike glycoprotein I machinery [1.575 ± 0.01]. We report the first of its kind of natural furin inhibitor(s) which would disrupt the furin machinery of SARS-CoV-2 and help in controlling the COVID-19 contagion. Communicated by Ramaswamy H. Sarma

A Note on Estimating the Case Fatality Ratio for Novel Corona Virus Disease (COVID-19)

Background: In this paper, an attempt has been made to estimate the Case Fatality Ratio (CFR) for coronavirus disease of India and a few selected countries. And also, it highlighted the pros and cons of obtaining crude and adjusted CFR of COVID-19 pandemic. Material and Methods: Data extracted from the WHO situation report and the University of Oxford website have been used for this analysis. The CFR and its 95% confidence interval were computed, trend and bar plot was used for graphical representation. Results: The worldwide crude CFR stands 6.73% (95% CI 6.69 to 6.76) based on 21, 83, 877 confirmed and 1,46,872 death cases(as on 17th April, 2020). Belgium was the highest CFR at 13.95% as compared to others. However, India’s CFR was found to be around 3.26% (as on 17th April, 2020). Conclusion: In conclusion, the estimation and interpretation of CFR are critical in response to ongoing COVID-19. The initial CFR estimates are subject to change, still, it is useful for healthcare planning over the coming months. Moreover, the precise and robust estimates of CFR will be available only at the end of the epidemic.

Impacts of COVID-19 on World Economy and Sustainable Development Goal in Nepal

COVID-19 has multifaceted impacts in economic and development sectors. Major economic impacts have raised the problem to meet the sustainable development goals in Nepal. In boarder scales, pandemic has affected to the national and international target of Sustainable Development Goals (SDGs). In this context, we have investigated the impacts of COVID-19 on different economic sectors and sustainable development goals in Nepal. The investigation was conducted using journal articles, government documents, policy reports, and conference papers, national and WHO situation reports, World Bank analysis data, COVID-19 web portals and UN sites of SDGs were reviewed. The study found that pandemic has triggered the most severe economic crisis in the world. The global output was declined, global trade are shrunk, labour markets (working hours, job losses and prosecuted shutdown of business) were seriously affected. The global GDP has declined and global economic recession has found extreme. This shrink in economics is expected to reverse global years of progress toward development goals and could force people back into extreme poverty. In Nepal, economic impacts of COVID-19 have made unable to meet the SDGs target to 2030. The economic road map of SDGs such as no poverty, zero hunger, economic growth are negatively affected. However, vaccination campaigns with international collaboration can lead positive economic influences in Nepal.

A cross-sectional seroprevalence for COVID-19 among healthcare workers in a tertially care hospital in Taiwan

BackgroundHealthcare workers (HCWs) are at the frontline during the pandemic of COVID-19 globally. According to the WHO situation report at April 17, there were 22, 073 HCWs contracted the infection. Whether the infection control policy and practice in the hospital setting can protect the HCWs is an important issue.MethodsWe performed a cross-sectional serology study in a tertiary care hospital in Taiwan to explore the sero-prevalence rate among HCWs. The participants are enrolled on a voluntary basis. A structured questionnaire was collected to gather the epidemiology character and risk factors for potential exposure. ELISA tests as Architect SARS-CoV-2 IgG (Abbott) and Elecsys Anti-SARS-CoV-2 assay (Roche) were used to detect antibody responses. If any of the tests was positive, a western blot assay was used for confirmation.ResultsThere were 194 HCWs participated during July 1 to Aug. 31, 2020. The mean age was 36.3 ± 10.4. More than half of the participants had possible hospital associated risk for COVID-19 exposure (110/192, 57.3%) and 64 had possible community risk for COVID-19 exposure (64/194, 33.0%). There was only one participant had positive test by Architect IgG test and confirmed to be negative for seasonal coronavirus and SARS-CoV-2 antibody. (Mikrogen Diagnostik, Germany).ConclusionThe cross-sectional serology study in a tertiary care hospital in Taiwan revealed no HCWs had positive serology response to SARS-CoV-2. We believe that the infection control policy and practice in the hospital and in the community are both important to prevent the disease transmission.

COVID-19 and the Financial Markets’ Volatility and Returns

The study is undertaken to investigate the impact of COVID-19 on the Financial Markets ‘Volatility from the period April 2020 to June 2020. Ten countries namely Pakistan, USA, China, UAE, UK, Spain, France, South Korea, Switzerland, and the Netherlands were selected. Our daily data comes from the WHO situation reports (COVID-19 statistics) and Pakistan, USA, UK, UAE, China, France, Netherlands, Switzerland’s, Spain, and South Korea Stock Exchange Indices database, respectively. We use the KSE-100, S&P 500, FTSE 100, SE 50, AEX, ADX, IBEX, FCHI, KRX, and SSMI 3-month realized volatility index as a proxy for the Pakistan financial markets’ volatility. We test a simple Ordinary Least Squares (OLS) regression investigating the new coronavirus impact on the financial volatility and we use a stepwise procedure. Independent variables included Global COVID-19 Confirm case, Fatality, Country COVID-19 new case, Country Fatality, and dependent variable included country’s market volatility, and market returns. Control variables of the country’s Exchange and Interest rate were also included. The study design is descriptive and analytical using the quantitative method with the application of Eviews. The results suggested that the Global COVID new case seems to have a significant negative impact on the country's market volatility, however, global fatality seems to increase market volatility. Country-specific cases seem to negatively affect that country's volatility however, country-specific fatality doesn’t seem to be significantly impacting volatility. Apart from that, interest and exchange rates seem to increase the volatility. However, the effect of these variables on returns remained insignificant. The findings of this research provide policy implications to investors and policymakers indicating that pandemics can significantly perpetrate business economics.

COVID-19 epidemic outside China: 34 founders and exponential growth

COVID-19 raised tension both within China and internationally. Here, we used mathematical modeling to predict the trend of patient diagnosis outside China in future, with the aim of easing anxiety...

COVID-19 causes more mortality of men than women, why and how? Scientists view

As of August 6, 2020, 15;46 GMT COVID -19 cases were 19,062,200 and deaths were 712,741(1). Since the inception of Covid-19, countries around the world are reporting the mortality rate of COVID-19 is significantly higher in men than it is in women. In almost all countries where data is available, it appears men are dying at a higher rate once infected with COVID-19 (2). Research suggests that mast cells in women are able to initiate a more active immune response, which may help them fight infectious diseases better than men. Initial reports from China revealed the early evidence of increased male mortality associated with COVID. According to the Global Health 50/50 research initiative, nearly every country is now reporting significantly higher COVID-19-related mortality rates in males than in females as of June 4 (3). As regards sex of the first deaths reported by the China National Health Commission (NHC) a review was done. The NHC reported the details of the first 17 deaths up to 24 pm on January 22, 2020. The deaths included 13 males and 4 females (4). According to the WHO Situation Report no. 7 issued on Jan. 27,71% of cases were male. (5)

Will Covid-19 cases in the World reach 4 million? a forecasting approach using SutteARIMA

The objective of this study was to determine whether Covid-19 cases in the world would have reached 4 million cases with the SutteARIMA method forecasting approach. Data from this study were obtained from the Worldometer from 1 March 2020 to 05 May 2020. Data were used for data fitting from 1 March 2020 to 28 April 2020 (29 April 2020 – 05 May 2020). The data fitting is used to see the extent of the accuracy of the SutteARIMA method when predicting data. The MAPE method is used to see the level of data accuracy. Results of forecasting data for the period from 29 April 2020 to 05 May 2020: 72,731; 84,666; 92,297; 100,797; 84,312; 81,517; 74845. The accuracy of SutteARIMA for the period 30 April 2020 – 06 May 2020 shall be 0.069%. Forecast results for as many as 4 million cases, namely from 08 May 2020 to 10 May 2020: 3,966,786; 4,047,328 and 4,127,747. The SutteARIMA method predicts that 4 million cases of Covid-19 in the world will be reported on the WHO situation report on the day 110/111 or 09 May 2020/10 May 2020.

Will COVID-19 confirmed cases in the USA reach 3 million? A forecasting approach by using SutteARIMA Method.

Forecasting the number of COVID-19 cases in the USA can provide an overview and projection of the development of COVID-19 cases in the US so that policy makers can determine the steps that must be taken. This study aimed to determine whether COVID-19 confirmed cases in the USA would reach 3 million cases with the SutteARIMA method forecasting approach. Data from this study were obtained from the Worldometer data on 15 February 2020 to 2 July 2020. Data from 15 February 2020 to 25 June 2020 were used to performance data fitting (26 June 2020-2 July 2020). Data fitting is used to examine the extent of the accuracy of the SutteARIMA method in predicting data. To examine the level of the data accuracy, the MAPE method was used in this study. The results of forecasting data fitting on 26 June 2020 - 2 July 2020: 2,544,732; 2,590,888; 2,632,477; 2,671,055; 2,711,798; 2,755,128; 2,803,729. The accuracy of SutteARIMA for the period of 26 June 2020-2 July 2020 based on MAPE was 0.539% and the forecasting results that had been obtained were 3 million confirmed cases, namely from 05 to 06 June 2020: 1,981,299; 2,005,706; 2,030,283; 2,055,031. The SutteARIMA method predicted that 2 million confirmed cases of COVID-19 will be obtained on the WHO situation report on days 168-170 or 05-07 June 2020.

Pharmacological hypothesis: TPC2 antagonist tetrandrine as a potential therapeutic agent for COVID-19.

More than ten million patients worldwide have been diagnosed with coronavirus disease 19 (COVID‐19) to date (WHO situation report, 1st July 2020). There is no vaccine to prevent infection with the causative organism, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), nor a cure. In the struggle to devise potentially useful therapeutics in record time, the repurposing of existing compounds is a key route of action. In this hypothesis paper, we argue that the bisbenzylisoquinoline and calcium channel blocker tetrandrine, originally extracted from the plant Stephania tetrandra and utilized in traditional Chinese medicine, may have potential in the treatment of COVID‐19 and should be further investigated. We collate and review evidence for tetrandrine's putative mechanism of action in viral infection, specifically its recently discovered antagonism of the two‐pore channel 2 (TPC2). While tetrandrine's particular history of use provides a very limited pharmacological dataset, there is a suggestion from the available evidence that it could be effective at doses used in clinical practice. We suggest that further research to investigate this possibility should be conducted.

Can we predict the duration of COVID-19 pandemic? an observational analysis

Background: Since the outbreak of 2019 novel corona virus pneumonia in the Wuhan city, China, the whole world has been ravaged by the pandemic of COVID-19. In this bleak scenario, China is witnessing the near cessation of the disease. The aim of the present study was to analyze the epidemiology curve of China and five other countries, and attempts to extrapolate these findings in the epidemiology curve of individual country to answer the question how long will the pandemic last on this globe.Methods: For the current study data from six countries namely China, Germany, Italy, South Korea Singapore, and India were considered. The resources for data collection were WHO Situation reports for corona virus disease (COVID-19), and Worldometer statistics for corona. Data were entered in to excel sheet and analyzed.Results: Data for total cases, active cases, death, recovery, inactive cases were analyzed for each country and construed in graphs. The epidemic curve of total cumulative cases in China can be observed to have four phases and the total duration of epidemic is around 24week±2 weeks. China is in last phase of the epidemic. In South Korea, Germany, Italy the epidemic curve of active and inactive cases has crossed each other and are in 3rd phase. India and Singapore are in phase 1.Conclusions: Despite the multitude of variables of COVID-19, the glimmer of hope for the end of pandemic can be inferred from the analysis of China, South Korea, Italy and Germany and can be extrapolated for India and Singapore.

The pattern and trend of COVID-19 spread in the Eastern Mediterranean Region: curve-fitting models estimation.

IntroductionThis study aimed to use the Curve Estimation Procedure to assess the pattern and trend of COVID-19 spread in the countries of the Eastern Mediterranean Region (EMR) by finding the model best fit for the observed COVID-19 data in each country between 20 February 2020-21 April 2020.MethodsThe number of daily confirmed COVID-19 cases, recovered cases, and during the period 20 February 2020-21 April 2020 in 21 countries in EMR were extracted from the WHO situation reports. The Curve Estimation procedure was used to produce different curve estimation regression models for the observed data in each country.ResultsDuring this observed period, the total number of confirmed cases, recovered cases, and deaths in the region were 138673, 71343, and 6291, respectively. The overall fatality rate in the region was 4.5%. The quadratic model and the cubic model follows the observed data points fairly well during the observed time period in five and nine countries, respectively. The exponential model (Y = b0 * (e**(b1 * t))), the growth model (Y = e**(b0 + (b1 * t))), and the compound model (Y = b0 * (b1**t)) were the best fit for data during the observed time period in two, three, and two countries, respectively.ConclusionThe pattern of COVID-19 spread differed between countries in the EMR. This might reflect the variations in testing and implementation of public health measures. The best curve-fitting model was demonstrated for each country and it can be used for very short-term predictions.

The epidemiological plateau of Corona virus in Gulf countries: a descriptive statistics study

The novel SARS-CoV-2 belongs to the beta coronaviruses and causes a severe pandemic disease named as COVID-19. In late December 2019. WHO situation reports on 11 March 2020, declared that COVID-19 a pandemic due to its global spread. All Arab countries have reported COVID-19 cases. The confirmed cases of COVID-19 pandemic in Arab gulf countries were reported in the United Arab Emirates, Iraq, Bahrain, Oman, Qatar, Kuwait, and Saudi Arabia, respectively. The fatality case rates in Gulf Countries are less than 1% in Oman, UAE, Kuwait, Bahrain, and Saudi Arabia, yet it hits 7.5% in Iraq. In this manuscript, we try to interpret the pandemic statistically in gulf countries, especially in Iraq. Additionally, the distribution of COVID-19 confirmed cases based on ABO blood groups were investigated. Epidemiological analyses revealed that a decreased risk of infection was attributed to blood group O compared to non-O blood groups, whereas people with the A and A.B. blood groups showed the highest risk for COVID-19 infection. Besides, high risk for diabetes, cardiovascular disease, blood clotting, and interleukin secretion was also related to blood groups in different orders. Accordingly, patients with a specific blood group that are associate with the above diseases should be under strict medical surveillance when infected with COVID-19 to reduce complications and severity. This study provides further confirmation for the previously reported correlation between the ABO blood groups and the susceptibility to COVID-19 infection.

Implications of gastrointestinal manifestations of COVID-19

In late December, 2019, the first case of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in Wuhan, China.1 According to WHO situation report 99, there have been more than 2·95 million confirmed cases of COVID-19 globally, with more than 202 000 deaths as of April 28, 2020.2

1,000,000 cases of COVID-19 outside of China: The date predicted by a simple heuristic

We forecast 1,000,000 COVID-19 cases outside of China by March 31st, 2020 based on a heuristic and WHO situation reports. We do not model the COVID-19 pandemic; we model only the number of cases.The proposed heuristic is based on a simple observation that the plot of the given data is well approximated by an exponential curve. The exponential curve is used for forecasting the growth of new cases. It has been tested for the last situation report of the last day. Its accuracy has been 1.29% for the last day added and predicted by the 57 previous WHO situation reports (the date 18 March 2020).Prediction, forecast, pandemic, COVID-19, coronavirus, exponential growth curve parameter, heuristic, epidemiology, extrapolation, abductive reasoning, WHO situation report.

Old test for the diagnosis of novel corona virus infection: Role of GeneXpert in COVID-19 testing.

Dear Editor, We are dealing with the COVID-19 pandemic of unprecedented scale with total number of cases at 8,993,659 with 469,587 deaths as per latest WHO situation report on 23thJune 2020.[1] Various tests available for diagnosis of COVID-19 infection include RT-PCR, isothermal amplification methods, antigen and antibody testing. RT-PCR is considered standard of care for diagnosis of COVID-19 and data about sensitivity and specificity are being scrutinized. Positivity rate varied based on specimen for analysis; In 205 patients tested by RT-PCR; positivity rates were 93% for bronchoalveolar lavage, 72% for sputum, 63% for nasal swabs, 46% for fibro bronchoscope brush biopsy and 32% for throat swabs.[2] However, false negative rates of COVID-19 tests range from 2-29%, placing sensitivity between 71-98%.[3] Various issues involving RT-PCR are cost, processing time and complex methodology. Testing with RT-PCR has been recommended 24 hrs before elective surgery by various surgical societies.[4] According to Indian Council of Medical Research high risk patients undergoing elective surgeries should have two negative RT-PCR tests 24 hrs apart.[5] It also has the drawback of long processing time which may lead to delay in life saving surgery or procedure. WHO has authorized the use of GeneXpert® platform for testing COVID-19 patients.[6] It can make a difference in testing strategy for COVID-19 in critical situations like emergency surgeries and other lifesaving radiological interventions, health care worker testing and testing in ICU patients. Primary care physicians play an important role in the emergency areas at community level, they come across variety of illnesses; as they are the first contact care providers. Primary care physicians can decide about need of urgency of some intervention and which test (RT-PCR vs GeneXpert) will be required as per the situation at their disposal. Various advantages include already available set up worldwide, trained manpower, less processing time (around 45 mins), around 96 tests in 24 hours, half the cost as compared to RT-PCR and use in African, Asian and Latin American countries.[6] United States Food and Drug Administration has also given emergency use authorization for Xpert ®Xpress SARS-CoV-2 testing modality. Although sensitivity specificity data is not available for GeneXpert in COVID-19, it has reliable and pathbreaking data from sputum testing in tuberculosis. When used as initial diagnostic test in place of sputum smear microscopy Xpert MTB/RIF has sensitivity of 88% and specificity of 99%.[7] Advantage of RT-PCR over GeneXpert is the ability to process larger number of samples simultaneously. So, The RT-PCR is best suitable for mass scale testing and use of GeneXpert can be lifesaving in emergency settings. Although all tests other than RT-PCR have not been standardized; GeneXpert will be a boon for testing in above discussed situations. It is being used in various hospitals and medical research institutes across India. However, we have to keep in mind issue of testing for tuberculosis in patients especially in Africa and Asia, so large scale diversion of GeneXpert testing machinery has to be avoided. Post Graduate Institute of Medical Education and Research, Chandigarh, India has taken initiative in GeneXpert testing in emergency situations like lifesaving radiological procedures and surgeries. To Summarize GeneXpert is rapid test for COVID-19 with processing time of around 45 mins and less cost Less expertise is required as already available set up for GeneXpert-MTB testing in India Can be lifesaving in emergency situations as interventions can be done at earliest. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Analysis coronavirus disease (COVID-19) model using numerical approaches and logistic model

The coronavirus disease (COVID-19) is a global health care problem that international efforts have been suggested and discussed to control this disease. Although, there are many researches have been conducted on the basis of the clinical data and recorded infected cases, there is still scope for further research due to the fact that a number of complicated parameters are involved for future prediction. Thus, mathematical modeling with computational simulations is an important tool that estimates key transmission parameters and predicts model dynamics of the disease. In this paper, we review and introduce some models for the COVID-19 that can address important questions about the global health care and suggest important notes. We suggest three well known numerical techniques for solving such equations, they are Euler&#39;s method, Runge–Kutta method of order two (RK2) and of order four (RK4). Results based on the suggested numerical techniques and providing approximate solutions give important key answers to this global issue. Numerical results may use to estimate the number susceptible, infected, recovered and quarantined individuals in the future. The results here may also help international efforts for more preventions and improvement their intervention programs. More interestedly, for both countries, Turkey and Iraq, the basic reproduction numbers <em>R</em>₀ have been reported recently by several groups, a research estimation by 9 April 2020 revealed that <em>R</em>₀ for Turkey is 7.4 and for Iraq is 3.4, which are noticeably increased from the beginning of the pandemic. In addition, on the basis of WHO situation reports, the new confirmed cases in Turkey on 11 April are 5138, and in Iraq on 29 May are 416, which can be counted as the peak value from the beginning of the disease. Thus, we investigate the forecasting epidemic size for Turkey and Iraq using the logistic model. It can be concluded that the suggested model is a reasonable description of this epidemic disease.

Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018–2019

IntroductionAs of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. MethodsWe collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018–2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. ResultsAs of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013–2016 West African outbreak. ConclusionThe difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.