The DRC Outbreak is Slipping Out of Control

The Democratic Republic of the Congo (the “DRC”) has a good record of controlling Ebola, but this time is different.

The central problem is that standard procedures cannot be fully implemented because the outbreak is in a conflict zone, North Kivu in the northeastern part of the DRC. Violence has been so serious that the CDC has withdrawn three of its Ebola experts to Kinshasa, 1,500 kilometers away. Axios, Oct. 18, 2018. Update: The director of the CDC argued for leaving experts in the outbreak zone but was overruled by the Trump administration. Stat, Oct. 24, 2018.

Additionally, it is becoming clear that a much greater proportion of new infections than in prior outbreaks are in children. This may be due to traditional healers who are unwittingly infecting children brought to them for treatment of malaria. PBS, Oct. 20, 2018. This new vector of transmission needs to be confirmed and controlled.

The PBS report also notes that,

Over the past three or four weeks, a growing proportion of cases have been people who were not identified as contacts of previous cases. And increasingly, even retrospective attempts to figure out how these people became infected are failing to chart the links.

This, along with the growth in cases, is a key indication that the epidemic is spinning out of control. Update: An excellent piece in Stat has a slightly more optimistic spin, saying that community cooperation is increasing. Stat, Oct. 25, 2018.

WHO expressed concern last week but failed to declare the epidemic a public health emergency of international concern (a “PHEIC”). WHO’s Statement, 10/17/18. WHO is understandably afraid of causing unnecessary alarm, but critics fear a repetition of its tragic inaction in the early stages of the West African epidemic. Stat, 10/17/1.

The availability of an effective vaccine is a tremendous advantage, but you have to know whom to immunize, and the conflict is impeding the standard contact-tracing process. The new transmission mode to children must be found and countered. It’s still possible that the North Kiva outbreak can be confined, but the risk that it will blossom into a big regional epidemic has dramatically increased.