Ebola outbreak threatens to escalate as violence rises

The Ebola outbreak in the Democratic Republic of the Congo is threatening to spiral out of control, with ongoing violence aimed at the Ebola response workers undermining efforts to stop spread of the deadly virus.

The statistics are grim: Double-digit daily increases in the case count are now the norm. Most new cases are people who never hit the radar of the teams searching for those who have been exposed to the virus, so they were never offered the experimental Ebola vaccine being used to try to contain the outbreak. Treatment centers are under armed guard, protecting health workers but discouraging people with Ebola from seeking their care, people familiar with the situation say.

Ebola treatment centers and roadside checkpoints have been torched; response workers have been beaten. On April 19, Dr. Richard Mouzoko, an epidemiologist from Cameroon working for the World Health Organization, was murdered when gunmen burst into a meeting he was leading.

Given the real threat to their staff, some organizations have reduced the number of non-Congolese workers they have on the ground in Butembo and Katwa, the epicenters of transmission. Contingency planning has some agencies simultaneously trying to figure out what conditions would prompt them to return some international staff to the outbreak zone and what might trigger a total withdrawal.

Ebola is currently killing about 66% of people who are being infected in this outbreak, now in its 10th month. As of Sunday, there were 1,572 cases reported and 1,045 deaths. It’s the second largest outbreak on record and will soon be four times bigger than the third on the list.

The frustrating thing for the people leading and working on the outbreak response is that the steps needed to stop an Ebola outbreak are well-known. Even in the days before the vaccine was developed, finding and isolating cases, monitoring the health of their contacts, and quickly isolating those who become sick and burying safely those who succumb has time and again broken the chains of Ebola transmission.

Ebola Congo
Photo: EPA

But this time, persistent resistance from the people in the affected communities, fueled by decades of conflict in the region, has rendered the response teams incapable of putting into effect these tried and true measures.

The failure to contain the epidemic is raising fears of catastrophe.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, called the situation unprecedented.

We are truly in uncharted Ebola-control territory,” Osterholm said. “Even in the 2014-15 [Ebola] epidemic in West Africa, once public health programs and vaccination efforts were put into place, it brought about a rather rapid reduction of cases. We’ve never encountered a situation where a geographic region becomes almost completely impossible to work in because of insecurity.”

“I think at the moment it’s in a phase where it could expand out of control very easily. Or we’re on the cusp of that already,” he said, suggesting cases could soon rise by 30 or 40 a day as opposed to the current 15 to 20.

The International Rescue Committee, one of the partners in the response, is working on the assumption that the true number of new cases every day is already double what the official figures show, said Bob Kitchen, vice president for emergencies and humanitarian action, who was recently in the outbreak zone to assess the state of affairs.

In January and February it appeared that control measures were beginning to have an impact. The number of new cases being diagnosed daily was starting to decline and it looked like the outbreak might be coming under control.

But in late February, fire-bombings at the Ebola treatment centers at Katwa and Butembo marked a tipping point, with Ebola control operations and staff coming under regular attack ever since.

Each violent event forces a temporary slowdown of control operations. Last Thursday teams vaccinated nearly 1,000 people in one day — a record. On Saturday, they weren’t able to vaccinate anyone in Butembo, because it was too unsafe for them to move about.

Because of the violence, all but two of IRC’s international staff have been pulled back to Goma, a regional hub that is about eight hours drive south of the major outbreak zone. To date the virus hasn’t moved into Goma, though the fear of that possibility haunts the outbreak responders.

Community anger at the Ebola response workers is just running too high in Butembo and Katwa, where opposition politicians and others have insisted Ebola isn’t real or is a disease outsiders brought to the area.

Overcoming the resistance is proving to be extraordinarily challenging. The people of Butembo and Katwa are highly suspicious of outsiders. So suspicious, in fact, that their definition of outsiders includes people from Beni, a city about 36 miles north that was the hotspot for Ebola transmission last autumn. Some of the organizations brought in workers from Beni thinking it would help with containment efforts, but they were not accepted.

With info from STAT

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