A rapidly spreading Ebola outbreak has killed at least 139 people, while healthcare workers in eastern Congo say they are underprotected and undertrained as the crisis moves through one of the world's most remote and vulnerable places. The outbreak has also pushed a U.S. national who tested positive in Congo into an isolation ward in Germany, with two other American doctors being monitored as authorities coordinate the movement of patients across borders.
Who Gets Protected First
A U.S. national who tested positive in Congo arrived in Berlin on Wednesday and was placed in a special isolation ward where a comprehensive examination was underway, German Health Ministry spokesperson Martin Elsässer said. Elsässer declined to comment on the patient's condition, and the patient has not been identified by German or U.S. authorities. The ministry later said it would take in the patient's wife and three children at the request of U.S. authorities, without elaborating further.
Dr. Satish Pillai, incident manager for Centers for Disease Control and Prevention's Ebola response, said Wednesday that the Americans were being transported in coordination with the U.S. State Department and other agencies. One patient, who is in stable condition, is now being treated in Germany, Pillai said. Asked whether the White House played a role in the decision to move the Americans to Europe, Pillai said the decision was based on conditions on the ground and the need to mobilize rapidly.
Who Pays the Price
In eastern Congo, the people facing the outbreak most directly are dealing with a collapsing health system, conflict, displacement and violence layered on top of the virus. Local leaders said an attack by militants linked to the Islamic State group killed at least 17 people on Tuesday night in Alima village in Ituri, a province that has become the hot spot of the outbreak. The World Health Organization has said patient zero has not been found.
Justin Ndasi, a Bunia resident, said, "It's truly sad and painful because we've already been through a security crisis, and now Ebola is here too." Tons of health supplies have been airlifted to Bunia, where the first known death was announced last week, but residents said masks are harder to find and some disinfectants that previously sold for 2,500 Congolese francs, about $1, now cost four times more.
At a treatment center in Rwampara, families cried and watched as healthcare workers in protective gear silently disinfected the bodies of their loved ones, suspected Ebola victims, and placed them into coffins for secure burial sites. Botwine Swanze, who lost her son, said, "He told me his heart was hurting. Then he started crying because of the pain. ... Then he started bleeding and vomiting a lot."
What the Authorities Call Response
The World Health Organization has declared the outbreak a public health emergency of international concern, worried over its scale and speed. The WHO chief in Congo says it could last at least two months. The rare type of Ebola, known as the Bundibugyo virus, spread undetected for weeks following the first known death while authorities tested for another, more common Ebola virus and came up negative.
Investigations continued into where and when the outbreak started, but Anaïs Legand, with WHO's emergencies program, said, "given the scale, we are thinking that it has started probably a couple of months ago." So far, 51 cases have been confirmed in Congo's northern provinces of Ituri and North Kivu, and two cases in Uganda, WHO Director-General Tedros Adhanom Ghebreyesus said Wednesday. There are 139 suspected deaths and almost 600 suspected cases. The London-based MRC Centre for Global Infectious Disease Analysis estimated that cases have been substantially undercounted and that the actual number could already exceed 1,000. "The true magnitude remains uncertain," it said.
This is Congo's 17th Ebola outbreak, and the WHO has said the country's health ministry has experienced staff and capacity to respond. Most outbreaks, however, were of the more common Ebola type. Dr. Vasee Moorthy, a special adviser at WHO, said a vaccine to address Bundibugyo would not be available for at least six to nine months.
Eastern Congo already faced immense pressure from conflict, displacement and a collapsing health system, said Dr. Lievin Bangali, senior health coordinator for the International Rescue Committee in Congo, adding that years of underfunding have weakened the response. The outbreak highlights the effects of the Trump administration's deep cuts in foreign aid. U.S. Secretary of State Marco Rubio has said the administration set a priority on funding 50 emergency clinics in affected areas. The U.S. pledged to contribute $23 million.
Crowded Wards, Thin Protection
In Bunia, schools and churches remain open while some residents wear masks. Elsewhere in Ituri province, suspected Ebola patients share a ward with others injured or ill at Bambu General Hospital. A Doctors Without Borders team identified suspected cases over the weekend at Bunia's Salama hospital but found no available isolation ward in the area, said Trish Newport, an emergency program manager. "Every health facility they called said, 'We're full of suspect cases. We don't have any space.' This gives you a vision of how crazy it is right now," she said on social media.
In Mongbwalu, where the body of the first known death was taken, the nearby border with Uganda remains open and gold mining continues, said Chérubin Kuku Ndilawa, a civil society leader. "There's no panic. People continue with their normal lives, but they're also starting to spread the word," said Ndilawa, and noted a lack of public handwashing stations. There were around 30 Ebola patients at Mongbwalu General Hospital, where a student from the local medical technology institute died on Wednesday, Dr. Didier Pay said.
Dr. Richard Lokudu, the hospital's medical director, said, "The patients are scattered here and there. We hope for the proper triage and isolation facilities to be installed today, and if that doesn't happen, we will be completely overwhelmed." He said they are understaffed and not trained to handle suspected cases, and added that if confirmed cases surge, "we have no protection."
In the Ebola-affected city of Goma, where Rwanda-backed M23 rebels are in control, the situation is complicated, said Dr. Anne Ancia, WHO's representative in Congo.