Ebola Strikes Again in the DRC
In any outbreak response, personal protective equipment for healthcare workers is critical (Wikimedia Commons).
The Democratic Republic of Congo is battling its sixteenth Ebola outbreak as public health officials race to curb infections and deaths.
DRC government officials declared the outbreak on September 4, following a 34-year-old pregnant woman arriving at a hospital in Kasai province with hemorrhagic fever. As of September 15, there have been over 80 cases, and 31 people have died, including four health workers. Africa CDC officials speculate that four of Kasai’s health zones and over 900 citizens have been affected.
Ebola is a zoonotic disease, meaning it originates in animal populations and is transferred to humans. Analyzing the viral genome of the most recent outbreak, experts found that it was 99.5 percent related to a previous outbreak in the DRC, suggesting the virus passed directly from an animal (most likely bats) to humans rather than evolving from previous versions of the virus. It is unknown exactly how the virus carried into humans this time. With symptoms including fever and internal bleeding, Ebola spreads through contact with bodily fluids. In the DRC, traditional burial practices that involve washing the body have quickened the outbreak.
So far, the virus' spread has been limited to Kasai, a remote region in the southwestern part of the country. However, the province is also on the border with Angola, creating a risk for cross-border spillover and a pandemic. Cross-border movement is common to flee violence, with 30,000 leaving in 2017. Considering a previous Ebola outbreak in 2014 that infected over 11,000 people around the world, the international community is paying serious attention to Kasai regardless. Local authorities have restricted movement within the province and locked down the district where the outbreak originated, Bulape. Despite this, there are already reports of local villagers fleeing into forests to avoid going to treatment centers, which are seen as death zones.
The DRC is especially vulnerable to the outbreak due to ongoing outbreaks (measles, cholera, and monkey pox) that weaken its health infrastructure, a history of political violence, and astronomical poverty rates. Over 18 million people require medical treatments already. Additionally, the country has suffered decades of war with neighboring Rwanda, the most recent of which is the M23 movement, and now localized violence between ethnic groups in Kasai have caused 1.4 million to be displaced.
Without U.S. aid, shortages in water and electricity are further inhibiting a safe health environment to combat the outbreak. Over six million people lack access to water and sanitation. In a statement provided to The Caravel, Dieu Merci Ngwayila, a Congolese entrepreneur watching the news from Kinshasa, reflected, “Honestly, I feel the government tries although life here is already very challenging. Electricity goes on and off. You could be hospitalized and needing a machine to keep you alive, but there is no electricity. Many people travel long distances just to find a hospital, and malaria is already a daily struggle. Now adding Ebola on top of this, I don't think the government alone can handle it. It will need outside help.” Dr. Ngolo further suggests areas where foreign donors could make an impact: strengthening local institutions, funding transportation of Ebola patients and staff, and providing training for community health workers.
Currently, the WHO and Doctors without Borders (MSF) are working to coordinate local public health responses. According to Dr. Patrick Otem, Program Area Manager for Emergency Response, they have provided personal protective equipment, medical supplies, and established treatment centers to enable outbreak response. However, diagnosis of the virus remains most critical, Dr. Joel Donat Ngolo, a Hospital Physician and Research Consultant in the DRC, told The Caravel, “The precarious infrastructure in Bulape remains the cause of diagnostic difficulties and the means of care unless the Ministry of Health has taken steps for a rapid diagnosis.”
In a statement provided to The Caravel, Dr. Brian Tse, former Project Officer in a U.S. medicinal research initiative BARDA, explained that the FDA approved the first Ebola virus by Merck in 2019, making it deployable in the current Ebola outbreak. Currently, the DRC has only 2000 Ebola vaccines, which is insufficient to vaccinate the millions living in Kasai, let alone the rest of the country. Although the WHO is sending 400 more vaccines, treatment relies mostly on supportive care, including monitoring vitals and managing the fever, and therapeutics called monoclonal antibodies. So far, vaccination efforts have focused on healthcare workers, with 68 workers vaccinated. Although the government has requested additional vaccines, the biggest problem remains adequate health infrastructure to store these vaccines, which require -80*C or -112*F for proper storage.
Ngwayila worried, “Many of us are worried because we know how dangerous Ebola can be. It is not a small thing. […] People move a lot from one province to another, and our health system is weak. Even if I am in Kinshasa, Ebola could spread here if not controlled quickly. That's why it scares us because it is not just for Kasai. It can touch and affect all of us.”