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No link between Ebola outbreaks in West Africa and the DR Congo

Burial teams from the Liberian Ministry of Health disinfect themselves before burning the bodies of Ebola victims in Marshall, Liberia.
Burial teams from the Liberian Ministry of Health disinfect themselves before burning the bodies of Ebola victims in Marshall, Liberia.
John Moore

The World Health Organization just confirmed that the Ebola outbreak in the Democratic Republic of the Congo is separate from the one occurring in West Africa.

"These findings are reassuring, as they exclude the possibility that the virus has spread from West to Central Africa," the WHO statement read.

The outbreak in the DRC is located in the remote Boende district, in the north-western part of the country. According to the release from the agency, a laboratory report stated, "the virus in the Boende district is definitely not derived from the virus strain currently circulating in west Africa."

Until this year, all previous Ebola outbreaks have occurred in Central Africa. The DRC has had seven outbreaks since 1976, when the first known Ebola outbreak occurred there (then Zaire).

The virus circulating now in the DRC is known as the Zaire strain, which is indigenous to the country. An epidemiological investigation showed that this outbreak started with the preparation of bushmeat —usually fruit bats or monkeys — for consumption on Aug. 11. So far, the WHO has identified 53 cases in the DRC, including 31 deaths.

Where will the Ebola outbreak move next?


(The Ebola outbreak 2014, courtesy of Health Map.)

To date, there have been suspected Ebola cases in Europe, Asia, and North America but none have tested positive. Public health officials are relatively unconcerned about Ebola becoming a big problem in the developed world. That's because outbreaks persist in countries with poor sanitation and a shortage of resources to contain them, not in resource-rich places like the US.

For this reason, continued spread in Africa is really what public health officials are worried about. "Our first concern is that this is going to go into adjacent areas through people traveling in the region," said Daniel Bausch, associate professor at the Tulane University School of Public Health and Tropical Medicine, who is working with the WHO and Médecins Sans Frontières on the outbreak. "In the short term, the main vector is the traveler: local people traveling from one village to the next. On a more regional scale, plane travelers." Travel from Sierra Leone, Guinea, and Liberia — the hardest hit countries — within the African continent is much more prevalent than travel elsewhere.

All countries in West Africa are already on alert. National authorities in Ghana, Nigeria, Togo, and Côte d'Ivoire are working with the WHO on prevention efforts and monitoring potential cases.

To do this, contact tracing is essential, said Bausch. "With Ebola outbreaks, most of the time there's one or very few introductions of the virus from the wild into humans, and all the transmission after that is human-to-human transmission. So people who are traveling locally as well as on planes and other modes of transport, that's the way this would get around."

The worst-case scenario

Even if the outbreak didn't move across any other country border, intensification within the already affected areas is the most immediate health threat. As of Aug. 29, there had been 3,069 probable and confirmed cases and 1,552 deaths. The number of cases continues to accelerate, with 40 percent of the total cases occurring in the last 21 days.

"The worst-case scenario is that the disease will continue to bubble on, like a persistent bushfire, never quite doused out," said Derek Gatherer, a Lancaster University bioinformatician who has studied the evolution of this Ebola outbreak. "It may start to approach endemic status in some of the worst affected regions. This would have very debilitating effects on the economies of the affected countries and West Africa in general."

"Ebola may start to approach endemic status in some of the worst affected regions."

This dire situation could come about because of a "persistent failure of current efforts," he added. "Previous successful eradications of Ebola outbreaks have been via swamping the areas with medical staff and essentially cutting the transmission chains. Doing that here is going to be very difficult and expensive. We have little option other than to pump in resources and engage with the problem using the tried-and-tested strategy—but on a scale previously unused."

Resources are already extremely constrained in most of the countries affected right now. As Dr. Bausch said, "If you're in a hospital in Sierra Leone or Guinea, it might not be unusual to say, 'I need gloves to examine this patient,' and have someone tell you, 'We don't have gloves in the hospital today,' or 'We're out of clean needles,' — all the sorts of things you need to protect against Ebola."

In these situations, local health-care workers — the ones most impacted by the disease — start to get scared and walk off the job. And the situation worsens.

When Bausch was in Sierra Leone in July, he said all the nurses went on strike in one of the hospitals where he was working. "There were 55 people in the Ebola ward," he said, "and myself and one other doctor."

He'd walk into the hospital in the morning and find patients on the floor in pools of vomit, blood, and stool. They had fallen out of their beds during the night, and they were delirious. "What should happen is that a nursing staff or sanitation officer would come and decontaminate the area," he said. "But when you don't have that support, obviously it gets more dangerous." So the disease spreads.