Ebola outbreak in Congo grows to become world’s 2nd-worst

An outbreak of the Ebola virus in an eastern province of the Democratic Republic of the Congo has become the second-largest epidemic of the deadly disease in modern history as public health officials struggle to contain its spread.

Congo’s health ministry said late Thursday at least 426 cases of the Ebola virus had been identified and of those infected, 245 are dead.

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That number surpasses a 2000-2001 outbreak in neighboring Uganda, in which 425 people were infected and 224 died. The worst Ebola outbreak in recorded history began in 2013 in the West African nation of Guinea, where it spread to Liberia and Sierra Leone and infected more than 28,000 people.

Public health experts say the outbreak in Congo’s North Kivu and Ituri provinces has been difficult to contain because of a combination of insecurity in a region where dozens of armed rebel groups operate freely and community distrust of the government.

North Kivu is home to more than 8 million people. More than a million of those residents are internally displaced by decades-long ethnic violence.

“Ebola’s overlapped with a hell of a crisis,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “What we have here is basically a civil war going on.”

Cross-border attacks from Islamist militants in Uganda and from anti-government militias have killed dozens in recent months, including several health-care workers, halting the response for days at a time. Some cases have cropped up in so-called red zones, areas that are out of the government’s control where health-care workers have little or no access.

After a bombing in September in the town of Beni, at the heart of the epidemic, health-care workers were locked down and the response to the outbreak stopped for a week amid protests over the insecurity.

“Some days we can’t move due to insecurity and have to cancel planned work at health facilities,” said Stacey Mearns, the Ebola response program director for the International Rescue Committee in Beni.

Congo’s health ministry said in a statement Thursday that field teams, tasked with identifying and vaccinating those who have come into contact with Ebola victims, are routinely harassed by groups of young people. One gang broke into a morgue last week to steal a body of someone who died from Ebola.

More than 37,500 people have received an experimental new vaccine, and last week the health ministry launched a first-of-its-kind randomized multi-drug test for a number of potential treatments. At least 160 patients have been treated with drugs that are still in the investigational phase, the World Health Organization (WHO) said.

But even getting patients to treatment has been a problem in the region, because few trust the government. That mistrust fostered the spread of Ebola in rural regions of Guinea, Sierra Leone and Liberia four years ago, feeding the virus as it spread through far-flung communities; the same situation exists in Congo.

“The population here has suffered for a very long time, with over 50 armed groups, 20 years of violence and conflict that has impacted all aspects of peoples lives, with major displacement. As a result the population is distrustful towards government and authorities,” Mearns said in an email. “Being this far into an outbreak with this on-going level of community resistance is worrying, it signals the long road we have ahead.”

Mearns said those who mistrust the government might hide sick relatives rather than taking them to a treatment center, or refuse to accept the vaccine.

Many believe the outbreak is likely to get worse before it gets better. Upcoming elections scheduled for next month are likely to exacerbate tensions between ethnic groups.

“I feel nervous about the next month with elections coming, and what that means for the security situation here. Any further deteriorations in security would have catastrophic effects on the outbreak,” Mearns said.

Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC), gave voice to those fears when he seemed to suggest this month that Ebola may become entrenched in the region. He later walked back those comments.

American agencies such as the CDC and the U.S. Agency for International Development have not sent responders to North Kivu, after the State Department warned of the tenuous security situation.

“We don’t believe that the Ebola outbreak currently is not containable. In fact in many health areas and health zones, it has been contained,” Peter Salama, the WHO’s deputy director-general of emergency preparedness and response, told The Hill in a recent interview.

But the expanding number of cases has officials concerned that the virus could jump across international borders into Uganda, Rwanda and nearby South Sudan. CDC officials have led a vaccination campaign among medical personnel in Uganda in anticipation of the virus’s spread, the first such vaccination campaign in a country that has not yet suffered from this outbreak.

The White House said this month that about three dozen American officials are working to support the outbreak response, either in Kinshasa or from Washington. The CDC has also deployed experts to Rwanda, South Sudan and to WHO’s headquarters in Geneva.

“We’re going to be slugging this out in the trenches. We’re now in the public health trenches. Just asking to war itself, this is going to be hand-to-hand combat in a way,” Osterholm said. “I think this one’s going to burn for a long time.”