Dec 7, 2018

Persistence needed to fight the "perfect storm" of Ebola in DRC

Data: Ministry of Health DRC; Chart: Andrew Witherspoon/Axios

Public health officials have the tools to fight the deadly Ebola outbreak that continues to rampage through the Democratic Republic of the Congo. Health workers are tracking down contacts, implementing vaccination and quarantine regimes, educating the community, treating patients, and watching for new signs of infection. But the fight's not going well.

The problem: A "perfect storm" of deadly disease combined with civil unrest, violence against health care workers, other diseases like malaria, and cultural norms that encourage the use of local clinics and traditional funeral practices, have led this to become the world's second-worst Ebola outbreak on record, according to World Health Organization spokesperson Tarik Jasarevic. It will take dogged persistence to contain this one, he said.

Others are even more skeptical. Arthur Reingold, head of epidemiology at UC Berkely, says "It's a mess, frankly."

"At the end of the day, we know how to stop Ebola, and there are new tools in terms of vaccines that are almost certainly beneficial and treatments that are likely beneficial. ... [But] fundamentally they can't do what we know needs to be done."
— Arthur Reingold tells Axios

What's happening:

  • WHO has roughly 300 and the DRC's Ministry of Health and its partners have about 800 people on the ground, working hard to trace contacts and contain the outbreak, Jasarevic says.
  • The disease is spreading to new locations, including Butembo, a city of 1 million. "We’re expecting this outbreak will last for a while, and we must increase our efforts to get it under control," Doctors Without Borders said in a statement.
  • Clinical vaccine trials continue, with the addition of a fourth investigational treatment, known as REGN-EB3, as soon as possible, according to the National Institutes for Allergy and Infectious Diseases.
  • Ahead of the Dec. 23 elections, DRC's Ministry of Health is "working with the National Electoral Committee to plan the installation of hand washing units and temperature checks at polls stations in the affected zones," per spokesperson Jessica Ilunga.

What needs to happen: Many objectives need to be met, sources say, including:

  • Teaching the local health clinics how to watch for and treat Ebola. Unsafe practices at the local clinics are suspected of being one of the causes for the larger number of babies and children with Ebola than normal, Jasarevic says.
  • Persuading families and communities to practice safe burial, since Ebola stays contagious in dead bodies for a period of time.

"This is against traditional practices of washing the body, guarding it and being present with the body to bring it to the next life," Reingold explains.

  • Encouraging the U.S. to rejoin direct public health efforts, since experts have left the epicenters due to its insecurity. NIAID tells Axios: "U.S. government workers, including a handful from NIAID, are working in Kinshasa, the capital city." WHO says they can "cover it" without the U.S. The lack of a major U.S. role in this outbreak is striking given the lead role the country played in the 2015 West Africa outbreak.

The big picture: Most sources expect the outbreak to last at least a couple more months due to its complications. "We are confident that it will be contained, but it will take some time. We have to be persistent," Jasarevic says.

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