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Already the second-largest outbreak in history, the Ebola epidemic that has killed just over 1,000 people in the Democratic Republic of Congo continues to grow and threatens to surpass the 2014 outbreak in West Africa that resulted in 11,325 deaths, an official at the Centers for Disease Control and Prevention (CDC) said.
“We’re very concerned. This outbreak does have the potential to be the largest outbreak if things remain unchecked and cases continue at the current pace,” Ray Arthur, director of the CDC’s Global Disease Detection Operations Center, told Yahoo News. “This outbreak has been going for a year now, the first cases were actually in April of 2018, but the outbreak wasn’t recognized and declared until August. But over the last three or four weeks, we’ve seen approximately one-fifth of all the cases, which represents a marked increase.”
Sectarian fighting has complicated the medical response to the virus from foreign governments and groups like the World Health Organization (WHO) and Doctors Without Borders. Even worse, health workers have been attacked by anti-government rebels, with 85 either killed or wounded since January, an official at the WHO told the Associated Press.
In October, when the number of reported cases hit 300, the Trump administration, citing security concerns, barred U.S. health experts from working or traveling to the Democratic Republic of Congo to assist in the latest outbreak. Doctors Without Borders pulled staff from the affected areas in February after attacks on treatment centers.
With fewer health workers on the ground in North Kivu, the province in eastern Congo where the outbreak is centered, the WHO shifted its strategy this week from attempting to track and vaccinate the contacts of those diagnosed with the disease, to opening pop-up vaccination clinics in relatively safe communities.
“We know that vaccination is saving lives in this outbreak,” WHO director-general Tedros Adhanom Ghebreyesus said in a statement. “We also know that we still face challenges in making sure the contacts of every case receive the vaccine as soon as possible.”
Proven components in containing past Ebola outbreaks — tracking and monitoring an infected patient’s contacts — have been difficult to achieve in the densely populated war zone, a fact that has further enhanced the need for a robust supply of the vaccine. So far, of the 5.7 million people who live in North Kivu, 111,000 have received the Ebola vaccine, and 30,000 of that number are health workers. Merck, the American pharmaceutical company that has developed the yet-to-be FDA-approved vaccine, is working to ramp up production. The scale of the need, however, has prompted the WHO to propose a strategy of cutting the dosage to stretch supply. Still, Arthur said, the prospect of mass vaccination for Ebola won’t be quick.
“If we could turn on a switch and do that overnight, we would. The U.S. government is working very closely with Merck to monitor their production schedule and supply, but it’s not easy to ramp up the production of a vaccine quickly,” Arthur said. “You have quality control testing, etc. There are efforts to ramp up the supply, but the timetable is not as fast as you might expect.”
In the meantime, fearing that the current outbreak of Ebola — which is transmitted through contact with bodily fluids and has killed 66 percent of those who have been infected — will spread to neighboring countries, the CDC has deployed personnel to the region.
“The longer the transmission goes on with the increased number of cases, one of our concerns is the larger population centers in North Kivu, a city called Goma, which is on the border with Rwanda and we’re quite concerned with cases occurring there which would increase the likelihood that they would cross over the border,” Arthur said. “There’s a lot of border traffic, in the neighborhood of 10,000 crossings each day, between [the Democratic Republic of Congo] and Uganda. Given that concern, CDC has deployed over 100 staff members to three at-risk countries, Uganda, Rwanda and South Sudan, to help those counties prepare to respond to a case should it occur.”
Arthur said mistrust of outsiders is common in North Kivu and a social media disinformation campaign has led many to believe that the Ebola scare is a hoax or that vaccinations actually cause the disease.
“The outbreak is not going to come under control without the cooperation of the community,” Arthur said. “It’s true with any Ebola outbreak. If the cases don’t want to identify the individuals they’ve had contact with, or if they don’t want to cooperate with the contact-tracing teams who come to visit them every day for 21 days or want to hide or whatever, then we really have challenges.”
The perfect storm of a deadly infectious virus, violent social upheaval and social media disinformation has health officials on edge and bracing for more bad news.
“Every wrinkle that could have happened in this outbreak seems to have occurred,” Arthur said. “That’s why we’re concerned, given the current trajectory. Definitely, things are going to get worse before they get better.”
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