The Democratic Republic of Congo is suffering from a fresh outbreak of Ebola. The disease re-appeared on April 4, 2018 in rural Bikoro before spreading to the city of Mbandaka, infecting 45 people and claiming the lives of 23. The city is a major transport hub located on the Congo river with a population of almost 1.2 million, sparking fears for a potential “explosive increase” in the number of cases. The World Health Organization has deployed 4,000 experimental vaccines to contacts of the infected, along with emergency workers and equipment in an attempt to contain the infection and prevent the formation of a new epidemic on par with the devastation of 2016.
The spread from the countryside to the city, 130 kilometres away from the first case is a “major development in the outbreak,” according to WHO official Peter Salama. Urban Ebola is “a very different animal from rural Ebola,” and maybe much harder to control. Indeed, the 2014-16 outbreak in West Africa was particularly deadly as the virus spread from the Republic of Guinea to Sierra Leone and Liberia via major transport links, ultimately killing 11,300 people. Officials are acutely aware of the danger; the WHO has called an emergency meeting of experts to determine the likelihood of the outbreak spreading beyond the Congo, and will decide whether the outbreak warrants an international public health emergency.
The Ebola virus spreads between humans via direct contact with contaminated bodily fluids of infected people or animals. It is highly infectious; the virus has spread so rapidly, partly because of misunderstandings and cultural traditions, including burial practices which involve touching and kissing the dead. Indeed, in Guinea, 60% of all cases were attributed to traditional burial practices during the 2014-16 outbreak. The WHO’s work in administering vaccinations will be invaluable in helping to contain the spread of Ebola, but educating locals on hygiene and changing sacred rituals will remain a vital yet challenging task in helping contain the outbreak.
The Ebola virus first emerged in Sudan in 1976 and had a fatality rate of 53%. Sporadic outbreaks have occurred since, with mortality rates ranging from 41 to a terrifying 93% in West African countries. The most severe outbreak raged from 2014-16, infecting 28,616 and killing 11,310. Poor health facilities in Western Africa, combined with a lack of disease awareness and cultural traditions helped perpetuate the spread of disease, whilst the emergence of the virus in densely packed urban areas enabled Ebola to spread like wildfire.
The way Ebola causes disease is deeply traumatic; the virus causes hemorrhagic fever, where individuals experience vomiting and diarrhea before bleeding both internally and externally, usually causing an agonizing death by low blood pressure two weeks after symptoms appear. The re-emergence of Ebola two years on will be deeply concerning, both for West Africans living in fear of another epidemic, and for health professionals, who will no doubt be wondering whether we will ever eradicate Ebola.
The re-emergence of Ebola is deeply worrying for health professionals and Congolese people alike. The prospect of another epidemic with a devastating fatality rate is a terrifying prospect, particularly for a disease that causes such an agonizing death. The WHO’s immediate action in containing the outbreak through vaccinations will be invaluable, yet they will have no doubt learnt the lessons from the past epidemic.
Education of locals may be one of the most challenging aspects of dealing with the outbreak, particularly when that involves disrupting cherished traditions such as burials in deeply distressing situations. Much work will no doubt be done to contain this outbreak, but the re-emergence two years on will be raising fears and doubts as to whether we can ever truly eradicate such a horrendous disease.
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