The current Ebola outbreak in the Democratic Republic of Congo, already the seventh largest in history, is on the verge of spinning out of control, the World Health Organization said Tuesday.
While cases of Ebola had slowed from 40 to about 10 a week in the past few months, political instability has led to rioting and suspicion of government forces, which has sidelined health workers in an epicenter of the outbreak, putting that progress at risk.
In a press conference, the WHO warned of a “perfect storm” of factors that could worsen the widespread outbreak as an estimated 100 people have died and 150 have been infected so far in the North Kivu northeastern province of DRC.
Ebola, a hemorrhagic fever, spreads through exposure to bodily fluids, which are increasingly shed as the disease progresses, making immediate quarantine and continuous treatment paramount to stopping an outbreak. As new political violence and a recent misinformation campaign make the region increasingly difficult for medical workers to operate in, the risk of those infected with Ebola remaining in the community ― and further spreading the outbreak ― increases.
Dr. Peter Salama, WHO’s emergency response chief, told HuffPost that the escalating violence in the area is limiting the access of medical professionals to Beni, a city of just under a quarter-million people that is one of the epicenters of the outbreak.
Salama stressed that the WHO now estimates it may take several more months to contain the outbreak, well above the initial three projected. More international and financial support would be needed to maintain response efforts.
The latest and most violent attack believed to be carried out by the rebel group Allied Democratic Forces (ADF) on Saturday killed 17 civilians, Salama said. Since then, Beni has entered into a state Salama called a “ville morte,” which means dead city and refers to public mourning. This mourning turned into anger directed at the DRC government for its inability to protect its citizens not only from this violence, but also from frightening outbreaks like Ebola, he said.
Public expressions of this anger include riots in the streets that police have controlled with tear gas, Hassan Coulibaly, a field director on the ground in Beni for the International Rescue Committee, told HuffPost.
This has led response teams from the government, WHO, and the various NGOs leading the effort in Beni to go on lockdown since Monday, waiting for the protests to end on Friday.
Global health leaders were pleased when the civil society leadership in Beni changed course Tuesday and announced it would allow health workers to continue their response efforts during the “ville morte” days.
“This is exactly the scenario that people have long feared with this outbreak,” Jeremy Konyndyk, a senior policy fellow for the Washington-based Center for Global Development who previously led parts of the 2014 Ebola response for the Obama administration, told HuffPost. “Losing a week or more of containment efforts is a big handicap, and will likely spawn more cases.”
Salama warned that youth groups in other parts of North Kivu were contemplating holding their own “ville morte” to stand in solidarity with Beni, which would potentially cause responders in other affected areas to go into lockdown.
Every day that health care responders are not allowed to track contacts of those infected for signs of the disease is another day that someone could come down with Ebola and begin spreading it to their friends and family, Coulibaly said.
“As the days go on, if we do see unsafe burials that can’t be responded to, if we do see symptomatic people that can’t be accessed ― we can see this situation deteriorating really quickly,” Salama said in a Geneva press briefing Tuesday. Health teams have only been able to follow up with a fifth of contacts in the last 48 hours in the Beni area.
“That’s a very scary scenario, where 80 percent of contacts we simply don’t know what happened to them today and yesterday,” Salama said.
“The amount of outbreaks DRC has had this year is unprecedented not only for DRC, but also for any country in the world.”
Salama added that there have been three suspected cases in the last two days that response teams have been unable to access in the lockdown.
He also told HuffPost that at least one confirmed case of Ebola, a person who has actively resisted treatment, is now in a red zone ― an area health care workers are unable to access due to the security risk. Health workers have been unable to treat or track this case and the resulting potential infection of others.
“The outbreak is expanding relentlessly,” Coulibaly told HuffPost. “People could die in their houses [during this lockdown] and if it happens and it’s Ebola-related and people touch the body” it would likely lead to the further spread of the disease, Coulibaly said.
Ron Klain, the Ebola czar under Obama, echoed the need for more of an international approach and investment to battling such dangerous outbreaks. While he praised the WHO for its quick and transparent response, he stressed that the insecurity in the region highlighted its limitations as an international organization.
″[The WHO] has no security force to enable it to operate in a conflict zone or where responders might be at risk. And it lacks the political stature to try to tamp down the ability of local leaders to play politics with a dangerous disease,” he said.
A Compounding Spread Of Misinformation
On top of the violence in the area and the logistical complications it presents, Salama pointed to the rise of political misinformation in light of the upcoming December elections in DRC.
Local politicians have seized upon the combination of the rebel attacks and Ebola outbreak to blame the government and raise tensions between the people and the public health responders, contributing to a rising rate of community resistance to treatment and outreach. Salama pointed to an uptick in social media posts about conspiracy theories regarding the outbreak that were inflaming such resistance and inhibiting response efforts.
“That resistance, driven by quite natural fear of this terrifying disease, is starting to be exploited by local politicians and we’re very concerned ... that exploitation of this very natural fear will gather momentum and make it even more difficult to root out the last cases of Ebola,” Salama said. This “frightening high-threat pathogen will exploit these community and political fault lines and not respect borders, whether provincial or international.”
“As the days go on, if we do see unsafe burials that can't be responded to, if we do see symptomatic people that can't be accessed — we can see this situation deteriorating really quickly.”
In any Ebola outbreak, there will usually be community resistance as outside forces descend upon an unfamiliar area, imposing quarantines and forcing safe burials that are not the usual tradition, Coulibaly said. Those in the hazmat suits can sometimes be seen as harbingers of death.
A spokeswoman for the DRC Ministry of Health stressed that years of rebel attacks “have created palpable mistrust towards all outsiders, especially public authorities and international organizations.”
Coulibaly argued that on top of that, there was a lack of people deployed who were from the communities affected ― in part due to the fragile state of the area ravaged by conflict.
“A crisis is the wrong moment to start building trust,” Dr. Ashish Jha, director of the Harvard Global Health Institute, told HuffPost. “You want to have built up that trust for years before the crisis.”
This lack of trust has caused some in the community who are ill to resist treatment and flee for miles into the bush to escape detection, Salama said. And that has helped make this outbreak incredibly widespread geographically ― over 200 kilometers (124 miles) from north to south. Such a spread makes accessing suspected cases in under 24 hours ― which is preferred to contain and control such an outbreak ― extremely challenging.
And anytime a patient is trying to actively hide Ebola for any reason, they jeopardize the safety of the community, Coulibaly stressed.
“They are not saving their own life, and they’re also killing other lives,” he said.
A Growing Number Of Outbreaks
The outbreak, which the Ministry of Health believes began after a man in Mabalako found an infected dead cat and brought it back home to eat it with his family, has continued to grow.
International authorities are particularly concerned because a case was discovered on the DRC bank of Lake Albert, which borders Uganda.
Doses of an experimental vaccine, over 11,000 of which have been deployed in DRC during this outbreak, are expected to arrive in Uganda on Thursday, Salama told HuffPost.
The WHO has yet to deem the current situation a Public Health Emergency of International Concern ― an emergency declaration for the most severe public health crises — though Salama said the organization is considering whether or not to call a meeting to discuss it this week considering the risk for international spread.
While the WHO, IRC and MSF all told HuffPost they have no current plans to withdraw, the escalating security risks are being actively monitored. A withdrawal of international assistance would be devastating to controlling the outbreak, Salama said.
The DRC has been battling public health crises all year ― this is the second outbreak of Ebola in 2018, and the country is also facing a polio outbreak and a yellow fever threat. For Salama and Jha, it’s only a reminder of the rising risks of the growing number of dangerous outbreaks that come with population growth, climate change and new migration patterns.
“The amount of outbreaks DRC has had this year is unprecedented not only for DRC but also for any country in the world,” a Ministry of Health spokesperson told HuffPost. “The entire system is doing its best to give the appropriate response to those outbreaks. But this really demonstrates the importance of investing more in improving and strengthening the overall health system.”
But for now, public health experts are waiting to see how the outbreak evolves in this moment of crisis.
“It just reminds us that we’re one outbreak away from this spreading globally,” Jha said.