Outside the Beltway

Central African Ebola Outbreak Hits A Major City

The Ebola outbreak in the Democratic Republic of Congo has reached a major urban center.

Doug Mataconis · Thursday, May 17, 2018 · 5 comments

Last week, I noted that Ebola had apparently reared its head in Africa again after the 2014 outbreak that killed more than 11,000 people, infected some 28,000, and resulted in the first-ever spread of the virus to the United States and the west. Rather than Western Africa, though, this time the outbreak appears to be taking place in Central Africa and is presently centered in the Democratic Republic of Congo. Now, The Washington Post  is reporting that authorities are concerned by the fact that the outbreak appears to have spread from rural areas into an urban center, which could make fighting its spread more difficult:

Congo has confirmed a case of Ebola in Mbandaka, a city of 1.2 million, marking the first urban case in the latest outbreak of the disease. The World Health Organization’s lead response official called the development “a game changer.”

Confirmed cases of Ebola had previously been limited to an extremely remote area more than 100 miles south of Mbandaka, in the rain forest of Congo’s Equateur province. The case in Mbandaka is only the third confirmed case of the current outbreak; 20 others are probable, and 21 are suspected, bringing the total of potential cases to 44. The death toll is now 23.

“This is a major development in the outbreak,” said Peter Salama, the WHO’s Deputy Director-General of Emergency Preparedness and Response. “We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there.”

The port city of Mbandaka lies on the eastern bank of the Congo River, Africa’s second longest after the Nile. Tens of millions of people live along the river, and the capital cities of Congo, Central African Republic, and the Republic of Congo lie along it and its tributaries.

Ebola is notoriously hard to contain, though recent outbreaks in Congo have been managed swiftly by the government and international global health institutions. This is the ninth Ebola outbreak in Congo since the 1970s, and the first since May of last year when five confirmed cases resulted in four deaths in a province neighboring Equateur.

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The international response to the current Congo outbreak has been substantial, and is expected to grow in size and urgency after the announcement of a confirmed urban case. On Wednesday, the WHO delivered 4,000 injections of an experimental vaccine with proven efficacy in recent trials, with more batches expected soon.

The WHO is also deploying 30 ”experts” to Mbandaka to ”conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases.”

Persistent rain and lack of roads has hampered the effort to contain the outbreak so far. Before Thursday, cases had only been confirmed in Bikoro, a small town whose health clinic only has ”limited functionality,” according to the WHO. Helicopter and motorcycle are the only ways to reach Bikoro from Mbandaka, but an airstrip has been rapidly cleared for small planes to land with supplies.

Part of the difficulty in deploying the vaccine is that it must be transported and stored at between -60 and -80 degrees Fahrenheit, which requires powerful refrigerators. The vaccine, produced by the pharma giant Merck, is not yet licensed, though the WHO has cleared it for ”compassionate use.” Its deployment is being financed by Gavi, the Vaccine Alliance, which is Geneva-based.

Containing an outbreak of a disease like Ebola is a difficult task to begin with, as the 2014 outbreak demonstrated quite well, but it’s obviously far easier to do in sparsely populated rural areas than it is in a densely packed urban center. Villages and towns that are subject to the outbreak can be more easily quarantined than a major city can, and there are methods available to prevent the infected from traveling far from the quarantine zone if proper methods are utilized, The same is not true in a major city. In that situation, it becomes far harder to contain even a mild virus like influenza, never mind something far more virulent like Ebola. The one advantage that health authorities have in this respect is that Ebola is not spread as easily as a virus like influenza or the common cold. Notwithstanding that, though, it doesn’t take a vivid imagination to see how an urban outbreak could manifest itself into a crisis rather quickly. Additionally, Mdbandaka’s location means that the virus could easily spread to other parts of the country, and to major cities in other nations, long before health authorities are able to contain it.

As I noted in my post last week, health authorities learned many lessons from the 2014 outbreak, and we now have what appears to be an effective vaccine against the virus that, if properly deployed, could go a long way toward containing an outbreak. Hopefully those lessons and that vaccine will prove effective this time.