New Ebola Outbreak Highlight Complications Of Fighting Multiple Outbreaks At Once

Alongside the Covid-19 pandemic and ongoing battles with cholera and measles, the Congo has now confirmed almost 80 new cases of Ebola. But what makes this 11th outbreak most frightening is the hotspots geographic proximity to Kinshasa, the Capitol of the country and home to more than 11 million people. The newest cases have been identified in Mbandaka (Équateur province), with an estimated 33 reported deaths in just the last few weeks.
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“The current Ebola outbreak is running into headwinds because cases are scattered across remote areas in dense rain forests. This makes for a costly response as ensuring that responders and supplies reach affected populations is extremely challenging,” explains WHO’s Regional Director for Africa Dr. Matshidiso Moeti. “Responding to Ebola in the midst of the ongoing Covid-19 pandemic is complex, but we must not let COVID-19 distract us from tackling other pressing health threats,” he warns.

However, with each day the likelihood Ebola will spread from one area to another, and internationally, grows. Not only because of continued violence in the region that has forced thousands to flee (often to other countries), but because of lack of access and reporting in remote regions. As the outbreak gains momentum, it has great potential to cross African borders like the Congo into Uganda, meaning further implications for other nations such as South Sudan and Rwanda cannot be ignored.

So what happens when a contagious disease with around a 50% fatality rate, incessant violence and distrust in the health system collide? The “perfect storm” for the spread of disease. Here’s what you need to know about the latest Ebola outbreak in the DRC and what the country’s Ministry of Health is dealing with to help prevent further spread of disease.

• There is a lack of trust in government that is driving unrest among the citizens and health care workers. Not only do many Congolese distrust their own government, but they distrust the health system associated with it, as well as the broader international organizations and NGOs. But this distrust, much like what the United States and other countries are seeing with Covid-19 misinformation and disinformation, has undermined local and international efforts to slow the spread.
• Like a growing number of viruses, Ebola is believed to cross from animals to humans, commonly affecting people and primates (monkeys, gorillas, and chimpanzees). Bats are believed to be the most likely source, carrying the virus and transmitting it to other animals, like monkeys and humans. Between humans, the virus spreads through direct contact with bodily fluids – both in those alive and from those who dead from the virus. 
• The incubation period for Ebola is between two and 21 days, with a mostly long incubation period. This means that those infected with Ebola might appear healthy during screening, and travel without knowledge of infection. As with any disease, tracking is near impossible when people do not stay in the same location, and likelihood of disease spread is greater – as is less interaction with health facilities and workers.
• The DRC has more than 500 “health zones,” difficult terrain, and extended areas without basic resources like clean water. The deadly virus can only be stopped if it’s properly tracked - meaning that those who are infected can be found, quarantined and even vaccinated. But given the extremely remote areas of the Congo without paved roads, the complications of so many disputed areas, limited electricity, and little contact with doctors, it can take days for people to come into contact with a health worker – and even longer to get any kind of necessary care. 
• However, the WHO contends almost 13,000 people have been vaccinated since the start of the 11th Ebola outbreak. According to new data, the experimental Ebola vaccines being used to try to contain the outbreak are protective 97.5% of the time. This gives great hope that with more funding and coordinated efforts (including rapid response testing and survivor research and support), the outbreak can be stopped before it resembles those of the past.
• According to the United Nations, more than 300,000 people have been displaced this month alone because of violence. There have also been hundreds of deaths and continued escalation of violence between groups that threated any health or diplomatic efforts.
• Violence against health workers has stymied efforts. Public Health efforts (usually through the work of community health workers) are vital for any success in the fight against Ebola. Health care workers throughout the region continue to face violence and infection, and have begun to demand security so they can do their jobs. Yet threats of strikes only seem to exacerbate fear, uncertainty and distrust in the system. Despite those challenges, community health workers have visited more than 40,000 households, and more than 273,000 people have been provided with health and safety information.
• While foreign aid is not the sole means of fighting this crisis, it has proven fundamental in assuring enough resources are available on the ground. Without additional resources, it’s impossible to have a steady supply of health care providers and equipment, keep vaccines in temperature-controlled environments, or get the needed people and necessities to the remote locations. On August 7th, the U.S. Agency for International Development (USAID) announced it is delivering $7.5 million in additional humanitarian assistance to the DRC for Ebola. However, the WHO is instrumental in directing the procurement and distribution of vaccines, testing facilities and on-the-ground expertise. And as of July 2020, President Trump notified the WHO that the U.S. would be withdrawing from membership.

 
Global health challenges are directly linked to national security. While for many in the Western world the Congo seems a long way away, Covid-19 has shown just how quickly a virus can spread without proper attention and resources. It has also highlighted for many just how important and difficult building trust and fighting bad information can be as it pertains to infectious diseases. The DRC’s 11th Ebola outbreak is a wakeup call for us all, and a reminder that we, along with the rest of the world, must avoid complacency.