Ebola DRC Outbreak: An alarming new development, explained



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At least 680 people has been infected with the Ebola virus in the Democratic Republic of the Congo. This is the second largest Ebola outbreak in history, with 414 deaths so far, and the first Ebola outbreak in active war zones, North North Kivu province and Ituri province in the DRC.

But that could be worse: Health officials this week worry that Ebola seems to be spreading towards Goma, the main population center in the DRC.

Only this week, the DRC health ministry confirmed four deadly viral cases in Kayina, a city in North Kivu, where fighting between rebel groups and militia has repeatedly disrupted the hard work of health workers who responded to the outbreak.

Kayina is in the middle between Butembo, currently one of the most worrying hotspots, and Goma, where a million people live.

So far, the outbreak has not affected the largest cities in the DRC. But Ebola in Kayina "increased alarm" for Ebola to reach Goma, Peter Salama, head of the new Emergency Health Program at the World Health Organization, told Vox on Friday.

Goma is the main transportation hub, with roads and highways leading to Rwanda. "This is a city of intersections and market cities," Salama added. The people there continue to do business, and also because of the feeling of insecurity in North Kivu. Ebola in Goma is a nightmare scenario avoided by WHO and DRC.

Together, they sent a rapid response team, including the vaccination team, to Kayina. And if the virus moves to Goma, Salama says that Ebola respondents are ready. They have mobilized teams there, set up laboratories, and prepared health centers where sick people can be treated separately.

But as Ebola experts Laurie Garrett wrote in Foreign Policy this week, Ebola in Goma can also trigger a declaration of global public health emergency that is rarely carried out by WHO, increasing the severity of an already dangerous outbreak.

The Ebola vaccine has not been matched by the social and political chaos of the DRC


WHO

When Ebola strikes, it's like the worst and most embarrassing flu you can imagine. People get sweat, along with body aches and pains. Then they start uncontrolled vomiting and diarrhea. They are dehydrated. These symptoms can appear anywhere between two and 21 days after exposure to the virus. Sometimes patients experience shock. In rare cases, they bleed.

This virus spreads through direct contact with body fluids, such as vomiting, urine, or blood, from someone who is already sick and has symptoms. More and more people are sick, and the closer they are to death, the more contagious they become. (That is why caring for a funeral that is very sick and attending is very dangerous.)

Because we don't have medicine for Ebola, health workers use traditional public health measures: finding, treating, and isolating the sick, and breaking the chain of transmission so the virus stops spreading.

They conducted a strong public health awareness campaign to remind people to wash their hands; that touching and kissing friends and neighbors is a potential health risk; and that funeral practices need to be modified to minimize the risk of spreading Ebola at funerals.

They also used a strategy called "contact tracking": found all contact people who were sick, and followed up for 21 days – the period in which Ebola was incubated.

In this outbreak, there are also additional tools: effective experimental vaccines. Since the outbreak was announced in August, more than 61,000 people have been vaccinated. But while the vaccine has hampered the spread of Ebola, it has not overcome social and political chaos in the DRC, which has been called the most overlooked crisis in the world.

"The brutality of the conflict is shocking," Jan Egeland, head of the Norwegian Refugee Council, told the Thomson Reuters Foundation, "ignoring the outrageous and international."

The presidential election has "increased" tension in a tense situation

On December 30, after years of delay, voters went to the polls to elect a new president. In the days leading up to the election, tensions in North Kivu were "turbulent," Salama said. Protesters stormed Doctors Without Borders in Beni, a recent outbreak hotspot, closing them for several days.

In January, the country's electoral commission announced provisional election results which signaled opposition leader Felix Tshisekedi might have won the election. But leaked data and external analysis show there are deviations from the number of voters that lead to electoral fraud.

"All outside observers – the African Union, European Union, Catholic Church – say the election results have been rigged," and people actually voted Martin Fayalu as president, said Severine Autesserre, a professor of political science at Barnard College, and author of the book Problem with Congo. When the final results are announced in the coming days, more protests and riots will follow.

But despite political instability not making the Ebola response easier, the war in the eastern provinces of Congo is a far greater challenge. The 25-year conflict has displaced more than one million people, and made the dangerous Ebola response work more deadly, Autesserre said.

Between August and November, Beni has experienced more than 20 violent attacks, which put the outbreak response there pausing for days at a time. That means countless cases, and Ebola continues to spread.

But there are also some more encouraging news, according to Salama: The outbreak of more than 200 people in Beni, a North Kivu city damaged by decades of violence, has been controlled.

"Many people will be very skeptical that the outbreak in Beni can be controlled as quickly as the strength of the infection that we saw in November and December, and the fact that we have nothing but volatility and insecurity since then," Salama said. "But the fact that Beni only has one case confirmed in two weeks gives us a lot of hope and optimism."

On Friday, the two biggest hotspots in the outbreak were Butembo, with 51 cases, and the neighboring city, Katwa, with 119 cases. But this epidemic spread geographically. There are active Ebola cases in 12 of the country's "health zones", districts where the DRC health system is regulated. Because of insecurity and difficulty reaching people, only 30 to 40 percent came from a list of known contacts, Salama said. That means the virus may already be in an undiscovered place.

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