Ebola outbreak in the Congo surpasses 600 cases

The world's 2nd-largest Ebola outbreak on record in the Democratic Republic of the Congo is showing no signs of slowing after at least 5 months, with the number of cases soaring past 600 and the death toll eclipsing 400 on Jan. 14.

Why it matters: The outbreak of the deadly virus, which causes fever, headaches, diarrhea and bleeding, has been exacerbated by insecurity in eastern Congo. The World Health Organization and nongovernmental organizations responding to the outbreak have never had to combat Ebola in such a threatening environment before, and some treatment centers have been destroyed.

Details: On Jan. 14, the Ministry of Health in the Congo reported that there have been a total of 658 cases, along with 402 fatalities (confirmed Ebola deaths plus suspected deaths from the disease) since the outbreak began in August in the provinces of North Kivu and Ituri.

• This makes this outbreak the 2nd-largest Ebola outbreak on record, well below the West Africa outbreak in 2014–16, which killed more than 10,000.
• Ominously, the number of cases under investigation as of Jan. 14 were 200.
• Unlike the largest Ebola outbreak on record, combatting the ongoing outbreak is largely being left to the World Health Organization.
• The U.S. has been reluctant to send specialists from the Centers for Disease Control and Prevention to the front lines due to the security situation, particularly in Beni, the epicenter of the outbreak.

What they're saying: Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, told Axios that the spike in cases under investigation likely has to do with Ebola workers resuming their work following election-related violence over the past few weeks.

• "My hunch is because there was a gap in response due to the election-related interruptions," Nuzzo told Axios on Tuesday.

Nuzzo says she worries about the lack of a broader, international response to contain the outbreak, since the longer it festers, the more likely it is to spread to different parts of the Congo, and to neighboring countries.

“What’s been missing from this outbreak is the international response.”

The WHO acknowledges the challenging circumstances facing its nearly 500 personnel in the Congo. "The Ebola outbreak in DRC is occurring in one of the most complex settings possible," WHO spokesperson Tarik Jašarević told Axios via email. "The main challenges are the security environment, pockets of mistrust among affected populations, and poor infection prevention and control in many public and private health facilities.

Why you will hear about this again: The Ebola outbreak in the Congo follows another Ebola outbreak in a different part of the country, and it comes soon after the Zika outbreak raised alarm from South America into parts of the U.S.

• With a burgeoning population, increases in migration and the lack of a robust international rapid-response force to respond to emerging epidemics, more outbreaks like this one are inevitable, Nuzzo and other health experts warn.

Go deeper: Read Axios' full Ebola coverage