Ebola Case In Urban Area Leaves Experts Worried About The Outbreak's 'New Phase'


The Democratic Republic of Congo has confirmed a case of Ebola in Wangata, one of the health zones of the regional capital of Mbandaka ― which is home to over 1 million people. 

The World Health Organization had reported two probable Ebola cases in Wangata earlier this week, affecting two brothers who were returning from a funeral in Bikoro, the epicenter of the outbreak. According to Dr. Oly Ilunga Kalenga, the country’s minister of health, one case later tested positive for Ebola.

With the confirmation of the Ebola case, Kalenga announced in a statement that the outbreak has spread to a “new phase” because an “urban health zone” is now affected by the disease.

“It is very concerning,” Dr. Ashish Jha, director of the Harvard Global Health Institute, told HuffPost. “Look, the reason why most Ebola outbreaks have tended to dissipate quickly is because they’ve mostly been in rural areas, so there haven’t been many people to spread it.”

When Ebola enters a more urban zone, there are more people to spread the disease and more contacts for health authorities to trace, Jha explained, making it much harder to track and contain. As of Monday, 432 contacts were being monitored for Ebola.

“The turning point is if additional cases spawned by [this Wangata case] start popping up,” said Jeremy Konyndyk, who led parts of the 2014 Ebola response for the Obama administration. Konyndyk is now a senior policy fellow for the Washington-based Center for Global Development. 

Another major concern is that Mbandaka, which contains the health zone of Wangata, is located on the Congo River ― the “superhighway of Central Africa,” according to Konyndyk.

This proximity to the Congo River creates a potential pathway for the disease to travel to the Democratic Republic of Congo’s capital, Kinshasa, which is home to over 12 million people. Then to the immediate north, there’s the capital of neighboring Republic of Congo, Brazzaville, whose population is 2 million. And the capital of the Central African Republic, Bangui, where over 730,000 people live, is not too far away.

It is very concerning. The reason why most Ebola outbreaks have tended to dissipate quickly is because they’ve mostly been in rural areas.
Dr. Ashish Jha, director of the Harvard Global Health Institute

While some may fear a repeat of the devastating 2014-2016 West Africa Ebola outbreak killed over 11,000 people ― in which the WHO was roundly criticized for a slow response ― both Jha and Konyndyk say two key factors substantially lower the risk of the current cases spiraling into a larger tragedy this time: The world is watching, and health workers are deploying an effective, albeit experimental, vaccine that was not available for trial until 2015.

The first batch of the unlicensed Ebola vaccine, developed by the pharmaceutical company Merck, arrived Wednesday in the DRC’s capital of Kinshasa. It will be targeted for use for “exposed health professionals, people who have been in contact with confirmed cases and contacts of these contacts,” according to Kalenga. 

Yet according to Jha and Konyndyk, only time will tell whether this outbreak gets substantially worse ― something Ron Klain, who served as Ebola czar under President Barack Obama during the last major crisis, has been concerned about.

“This [urban case announcement] confirms my worry that early reassuring messages from authorities were premature,” he told HuffPost. “This requires a more urgent and comprehensive response, and a need for increased U.S. leadership and involvement.”

Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, tweeted Wednesday that he spoke to U.S. Secretary of Health and Human Services Alex Azar and U.S. Agency for International Development head Mark Green on Tuesday. 

The U.S. National Security Council ― which disbanded its global health security division focused on combating pandemics last week, the day the Ebola outbreak was announced ― is now coordinating the U.S.’s Ebola response from the Centers for Disease Control and Prevention and USAID, according to an NSC spokesperson.

Andrea Hall and Dr. Luciana Borio are leading that response, the spokesperson told HuffPost. Hall leads the NSC weapons of mass destruction unit, which absorbed some global health security staff who had operated under now-departed Rear Adm. Tim Ziemer. Borio is the director of medical and biodefense preparedness policy and was formerly on Ziemer’s team.

The spokesperson said the CDC office in the Democratic Republic of Congo has deployed its 26-person staff ― 18 of whom are locally employed ― to tackle the outbreak. It also sent an epidemiological lead and a safety expert to the DRC. A senior Ebola expert is departing for the country shortly, and the agency has offered “technical expert assistance for surveillance, laboratory diagnosis, infection control, border health screening, health communication, vaccinations and emergency response management,” the spokesperson added. USAID has also sent personal protective equipment and lab equipment for testing.

The spokesperson also said the CDC invested in graduating 150 “disease detectives” from the Field Epidemiology Training Program in the DRC, helped set up its National Emergency Operations Center and assisted in drafting its self-assessment. 

However, The Wall Street Journal listed the DRC in February as one of the countries at risk of losing global health security funding. It’s unclear whether Congress’ recent $50-million funding increase to the CDC for global health security in the 2018 fiscal year will address the gap and save the DRC’s programming.

And last week, Trump proposed cutting $252 million in Ebola response funds for U.S. agencies through a rescission. 

The CDC and USAID should have all the resources they need. It will cost us more in every way if we don’t provide the needed resources now.
Beth Cameron, Nuclear Threat Initiative

“The U.S., its partners, and the WHO should pull out all the stops ― now and before the disease spreads further ― to assist the DRC to halt the spread of Ebola,” said Beth Cameron, who served as senior director for global health security and biodefense on the NSC under Obama and is currently the Nuclear Threat Initiative’s vice president for global biological policy and programs. “The CDC and USAID should have all the resources they need. We know it will cost us more in every way if we don’t provide the needed resources now.”

As of yet, the WHO Contingency Fund for Emergencies, The Wellcome Trust, the U.K., the UN, and Gavi, the Vaccine Alliance have contributed $8 million to contain the outbreak, which WHO estimates will cost at least $26 million to quell over three months. However, that was before news of the confirmed case in Wangata. 

Though only three cases of Ebola have been officially confirmed in the Democratic Republic of Congo so far, 41 other suspected or probable cases have been recorded since the start of the epidemic. In 23 cases, patients have died, said Kalenga, the country’s health minister.

The DRC has decreed free health care in the affected zones in light of the new case’s confirmation. Kalenga also warned people to “absolutely avoid touching and washing the deceased.” 

Unsafe burials were a major source of transmission in the 2014 outbreak. According to Reuters, WHO has sent 300 body bags to the affected communities to ensure safe burial practices during the current outbreak.

“This gesture [of not touching and washing the deceased] may shock but it can save your life and that of the entire community,” Kalenga said.

This is a developing story. Please check back for updates.



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