Health: The DRC Ebola Outbreak Is Spreading At A Rapid Pace. Why?

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0:25Today, we take you to the Democratic Republic of the Congo, home to more than 100 million people. The country is now more than three months into fighting the fastest growing Ebola outbreak in history. It's already the second biggest Ebola epidemic on record, and it's moving faster than any previous Ebola outbreak. At its current pace, it's on track to eclipse the West African Ebola outbreak of 2014 to 2016. That's Dr. Tedros Adhanam Ghebreyesus, Director General of the World Health Organization, speaking on August 12th. So far, the Congolese government has confirmed more than 5 ,000 cases and more than 2 ,500 deaths from Ebola, making it the deadliest outbreak in the country and the second deadliest outbreak ever.

1:16The virus is spreading at a record pace with 317 deaths last week. I'm Jen White. You're listening to the 1A Podcast. Today, we cover why the DRC is struggling to stop the Ebola outbreak, what patients and those taking care of them need most, and who's helping after dramatic cuts in U.S. aid to the region. We'll be back with more after this short break. Stay with us.

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2:21Your dog has watched you spend hours a week moving fabric between machines and has never once lost faith. The question was never whether you could become the person your dog thinks you are. It's what's in the way. Turns out, just the laundry. Not anymore. Or Rents picks up your laundry, cleans it expertly, and delivers it back while you get on with being magnificent. Sign up today at Rents.com. Rents. It's time to be great. Welcome back to the 1A podcast. We're talking about the Democratic Republic of the Congo and the country's fastest growing Ebola outbreak in history. We start with a nurse who until recently was caring for patients in Mangualu.

3:02That's a mining town of 130 ,000 people in eastern DRC. It's one of the epicenters of the Ebola outbreak. Mary Jo Frawley joins us now from California. She works with Doctors Without Borders. Mary Jo, welcome to 1A. Hey, thank you so much for having me. Pleasure to be here. And I'm grateful to be able to share some of the experiences and highlights of my experience. Thank you very much, Jen. Of course. How does this outbreak and the response compare to others you've experienced? Because you've worked in the DRC during previous Ebola outbreaks. Absolutely. I think you've heard the words that people have expressed it and described it as already as horrific and horrendous.

3:43I would ditto that. This has been one of the most overwhelming for healthcare workers as well as debilitating for communities and families that I've ever seen. I've been in 10 different outbreaks of viral hemorrhagic fever. This is the worst. This outbreak is caused by the Bundibujo species of Ebola. What's different about this specific species? Currently, it's not been researched widely. And the presentation is the same as the other viral hemorrhagic fevers. People have vomiting, fever, diarrhea. But the research on the treatment as well as the vaccine has not been researched deeply enough because it's not coming up as a frequent hemorrhagic fever.

4:42Thus, there's not much information of what to do with the treatment regime. So you were in DRC from May 25th to August 11th. And I just want us to better understand what you saw while you were there, but also what you were doing to try to aid in getting this outbreak under control. Well, I'd just like to bring a story and an imagination up of, imagine being in a community that is in the middle of the jungle, in a mining town, which is a rough town. and you're a healthcare worker and you've never done this before and you show up for work and you put on one of these uh ppe suits one of these zoot suits that you see people in and all of a sudden you're seeing your community members you're seeing your neighbors you're seeing your family members coming in on stretchers, in ambulances, sick and sicker.

5:44They have been affected in the community. They've been affected by taking care of their family members in the community. They are shocked, but they still continue to show up and give the kind of care, the kind of dignity that you would do for one of your neighbors or one of your family members. The fatality rate of Bundy Bujo in the DRC is almost 50 percent, as close as 70 percent in more remote places. And that's a terrifying statistic, Mary Jo. How are people there coping with knowing how deadly this infection can be? Well, when we first got there, it was even higher than that. It took us a few weeks before we had our first survivor, which was just a thrilling moment, walk out of the center.

6:46The smiles that people have, the hugs that people are able to give, the encouragement that the communities get by seeing survivors come out, by seeing smiling family members again are the encouragement and the inspiration that kept us going. They continue to do what's best for their community members by providing food, by providing a clean bed, clean clothes, clean.

7:26just doing what you would do for a patient to make their life more comfortable and to make their life more and their families more content with the care. You said that it was several weeks before your team saw someone survive the virus. What treatments are available for those who are infected? What we were able to do is we provided what we would consider ABCD care, which is we took care of their airway. We were able to give them oxygenation. We were able to hydrate them. The fluid loss is incredible. Buckets full of either, sorry to be so gross, but of fluids, body fluids. We were able to replace those.

8:18We were able to give oral fluids, IV fluids. We were able to manage system failure. These are the things that we pushed for every day as our team members suited up and went in to provide IV hydration, oral rehydration, and nutritional support, including patients' favorite drinks of Afia, which is a mango drink, and another marinda drink. We just kept pushing for standard care, antibiotics, anti-malaria treatment, you name it. We went for it all. As you've mentioned, this virus spreads through direct contact with bodily fluids of an infected person. It's highly contagious. How do you and other health care workers, both those who are professional health care workers coming in from a place like Doctors Without Borders, but also community members who are providing care, how much ability do you have to protect yourself from contracting the virus?

9:25We work in a very systematic, mindful, pragmatic way by putting on our gear appropriately, by putting on our PPE or our personal protective gear, and also taking it off pragmatically. We have a system of protocols, which includes disinfection in between each step. And by being able to implement that with our health care workers, both inside the ETC and also in the community, hand washing soap and water. This virus does not like soap and water. So we provide hand washing points. We provide instructions on how family members can go ahead, disinfect their houses, disinfect their clothes and just do good hygiene care to be able to provide safety.

10:26But it does require a different mindset instead of running in and racing after a patient that may be ill by thinking before you work. And by providing some pragmatic steps, we can be safe and we can do this. What supplies and resources are lacking right now? I'm actually not current on what's lacking at this point. I do know that there is an expanding outbreak with areas that we are not in that probably need basic PPE supplies, being chlorine for disinfection, being mask, goggles, in order to protect your face, in order to protect your body from the bodily fluids. I'm sure that those will be needed soon and needed in those areas.

11:29Briefly, Mary Jo, what do you want us to understand about this outbreak, the patients you were caring for, especially for people who are hearing about and experiencing this outbreak from a distance? of the resilience that my caregivers provided of the health care workers the service that they provided of the survivors that they provided francine was a patient that was just an inspiration for me to show up every day for she got sick we would see these patients get sick and then recover and then get sick and recover so it was a a combination of the health care workers continuing to never give up on the patient's attempt to get better of francine who took care of a little baby whose parents died inside the unit and the baby survived.

12:35These are the caregivers. These are the people in the community. These are the people that are really stepping up to the plate to be able to do it. And it's not just about the negative end of it. I just want people to know that both the local community as well as the international staff that's going in there and giving their all. They're all participating. Well, we have to take a quick break. More on the Ebola outbreak when we come back. Stay with us.

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14:27Capital One offers checking accounts with no fees or minimums. What's in your wallet? Terms apply. See CapitalOne.com slash Bank Guy for details. Capital One N.A. Member FDIC. Welcome back to the 1A podcast. We're talking about the Ebola outbreak in the Democratic Republic of the Congo and what you need to know. Let's bring in some new voices. Matthew Mpoké Big is East Africa Bureau Chief for The New York Times, based in Nairobi, Kenya. He joins us from the DRC. Matt, welcome to the program. Thank you so much, Jen. It's a pleasure to be on, and it was great to have a medical perspective from Mary Jo.

15:06Also joining us on the line from New York, another medical perspective, Dr. Selene Gounder. She's an infectious disease specialist and epidemiologist and the editor-at-large for Public Health at KFF Health News. Dr. Gounder, welcome back. Great to be here. And joining us in studio, Jeremy Keneindyke. He's president of Refugees International. That's an independent nonprofit advocating for refugees globally. He also served in the Obama administration from 2013 to 2017. He was director of USAID's Office of Foreign Disaster Assistance, where he led the U.S. government's response to international disasters.

15:41Jeremy, welcome. Thank you so much. And we want to hear from you too. What questions do you have about the Ebola virus? You can email us at 1a at wamu.org. We'd also like to hear from you if you've worked as part of a team responding to a public health emergency. What do you think we should know about what it takes to mount an effective response? Right now, let's hear from Julien Arnais. He's a United Nations Senior Ebola Coordinator, speaking earlier this week. The ebbler outbreak is growing exponentially. In the last three months, 2 ,500 people have died and half of those in the last 20 days.

16:20And the epidemic is spreading widely. It's now covering an area that is bigger than France. Matt, help us understand why this outbreak is spreading so quickly and over such a large area. I think there are specific factors in eastern Congo which makes this outbreak difficult to contain. The first is a fragmented healthcare system. Ordinary people who have health problems, instead of being able to access a unified government system, are offered the choice, depending on where they live, of government facilities, facilities run by churches or missions, private health care. And that means that it's much harder to join up the medical response.

17:16Another major factor is the insecurity in eastern Congo. It's a region that not just for years, but for decades, has been trying to overcome insurgencies by various rebel groups. In Ituri province, the epicenter of this outbreak, there's been effectively a state of martial law since 2021. And to give you one example of why that matters, we are planning to do a trip to an area just west of Ituri. And it's a road trip. And one of the major issues is the presence of rebels on the road who periodically have attacked vehicles. So, of course, that makes it much more difficult for aid groups and health workers to move around.

18:18Another factor is communities. Inevitably, at a time of a major public health scare, there is mistrust. And that exists here too. So there have been times when communities have attacked health or young men within communities, let me say, have attacked health facilities. Other times, workers who are trying to bury Ebola victims safely have also been attacked for various reasons. But of course, all of that impedes the Ebola response effort. Well, the current Ebola outbreak is caused, as we said, by the Bundibugio species of the virus, for which there is no vaccine nor treatment. Here's Health Minister of the DRC, Dr.

19:08Samuel Roger Kamba. In our planning, we decided with the advice of scientists to use the Ewebo vaccine, the vaccine that we all know, which has already been used several times, and particularly on a large scale during the 2018 to 2020 outbreak. Dr. Gounder, on Thursday, the World Health Organization and its partners said they'd provide 70 ,000 doses of the Ewebo vaccine. What hope does that provide here? Irvabo is licensed against the Zaire species of Ebola, and this outbreak involves the Bundabujo species. We don't actually know whether the Irvabo vaccine will protect against Bundabujo. There's some laboratory and animal data that suggests it might.

19:55Of that 70 ,000 doses you mentioned, 20 ,000 are going to a phase three clinical trial to assess whether this works, what the effectiveness is against Bundabujo. And the remaining 50 ,000 will go to frontline and health workers who will be told with informed consent that we don't know how protective this is. Now, this Bundabujo species seems to be particularly dangerous for children, especially children under five. And children currently make up a quarter of confirmed cases and almost a third of all the deaths. Dr. Gounder, why do they have a lower chance of surviving this strain? It's not actually that Bundabujo is different from the other Ebola species.

20:41Any Ebola species is more deadly to small children for a number of different reasons. So first of all, Ebola kills mostly through massive vomiting and diarrhea. And so you have massive fluid losses. For a small child, the difference between looks sick and goes into shock is much shorter. You also have a harder time getting fluids into those smallest of children, getting in an IV for fluid hydration, getting them to drink. They often arrive later because the symptoms look like malaria early on. And many of them are also getting infected by the adults who are nursing them because the adults themselves have been infected and are sick.

21:27Jeremy, you have experience with two prior outbreaks, the deadliest outbreak in history in 2014 in West Africa that killed 11 ,000 people, and then in 2018. Tell us about the role USAID played in that 2014 response. So that occurred at a time when the World Health Organization was at a pretty weak point in terms of its disaster response, its international emergency and outbreak capacity. And so So it forced the U.S. to step in and in some ways substitute for what WHO could do. In 2018, WHO had strengthened quite a bit through some major reforms and was able to play that role with a lot of – still a lot of support from the U.S.

22:08But in 2014, we sent a huge – what we call the DART or a disaster assistance response team to four different countries in the region, the three heavily affected, Sierra Leone, Guinea, and Liberia. And then briefly to Mali as well, because cases popped up there. And we're hand in glove with the national government. So we would, you know, my team leaders in those countries would be sitting with the heads of state in those countries on a weekly basis with their teams planning hand in glove on how this response would operate. That is almost totally absent now. USAID, of course, is gone. The State Department has sent a team that it's calling a DART, but it is nothing like what we sent to West Africa.

22:52It's dramatically smaller. It's not on the front lines. It's sitting in the embassy in Kinshasa on literally the other side of the country from where the actual outbreak is. They're not being allowed to go to the outbreak zone. So the U.S. is still writing checks, but it's not providing the kind of hand-in-glove, problem-solving leadership that was so critical in 2014. Well, we got this question from David who says, is the current Ebola outbreak directly tied to the destruction of USAID? Can you be specific? And just to provide a little more context here, last year, the Trump administration shut down USAID, which played, as we heard there, a key role in containing earlier outbreaks.

23:27And aid workers on the ground say cuts to USAID and the U.S. withdrawal from the World Health Organization in January have hindered and slowed down the world's ability to respond to this outbreak. So, Jeremy, to David's question, give us specific examples of where you see the impact of USAID's closure in this response. Absolutely. I wrote a piece for Zateo News a few weeks ago about some of this and some of the things that I would see. I would go back to how this started. So we know now that this has been going on at least since January. Nature magazine reported a few weeks ago that there's been research in Mongualu, one of the epicenter towns, that there were detectable signals of chains of transmission as far back as January.

24:13Taxi drivers avoiding certain neighborhoods, the cemeteries in the town being completely overloaded by the number of bodies that were coming in. And yet this was not confirmed until four months later in the middle of May. So that gave the virus a huge head start. And I think it's not a coincidence that at a time when many of the surveillance activities, the disease surveillance activities that USAID would support in eastern Congo, as well as this huge network of humanitarian health partners that USAID had supported in eastern Congo, almost all of that had been dismantled. And so both the formal way you might detect those signals, but also the informal way.

24:52You know, a hospital director having a weekly call with the USAID mission in Kinshasa and saying, we're seeing some weird stuff in Mungbalu. You know, there's no one to make that call and there's no one to receive that call in the same way that there would have been two years ago. So I think it contributed to the late detection and then a huge hollowing out of response capacity. and then the absence of the leadership and coordination and problem-solving operational role that USAID used to play as well. All of that's gone. So what I hear you saying is a combination of a loss of expertise in disaster response, but also a loss of relationships.

25:27Exactly. Okay. We're speaking to Jeremy Keneindyke. He's president of Refugees International. Also with us, Dr. Selene Gounder, an infectious disease specialist in epidemiology, and Matthew Mpoké-Big, East Africa Bureau Chief for The New York Times. Matthew, what are Congolese officials saying right now about the response, what they need, the effectiveness so far? Congolese officials have taken this outbreak very seriously. And what I'm hearing on all sides is that they've been very involved in providing the kind of coordination and being involved in the overall response. Just as impressive for me and from what I've seen has been the response of ordinary Congolese people who have stepped up to become volunteers and Congolese doctors who have taken part in trying to control the outbreak.

26:35I witnessed a scene at the weekend in which a man tragically died, a truck driver died in a village after vomiting blood. And within minutes, a team of Congolese volunteers had been mobilized to come to the scene, to secure the scene. They quickly put on protective equipment. They sprayed down the area with chlorine. They removed the body, put it in a body bag, following all of the protocols. And then they took it away to be tested. But what was really striking was how quickly they mobilized, how professional their sort of response was, but also there was courage too. They didn't exactly know the situation they were going into, but they felt that protecting the community was the paramount thing for them to do in that moment.

27:40So the response of Hongo as a country and particularly the people involved in the response here has been very impressive. Dr. Gounder, this is the second time we've heard this emphasis on how the community itself is responding to this outbreak. First from Mary Jo, who works with Doctors Without Borders, who was in DRC helping patients there. But I don't want to lose sight of the fact that there are also reports of a surge in indirect deaths as hospitals and doctors focus on the Ebola emergency. So routine care and vaccines like vaccine for measles might not always be a priority. Congolese officials say they're also battling other disease outbreaks in the country.

28:22So how overwhelmed is the health care system and infrastructure in the country right now? Right. It leads to people's resources, staff and other resources being redirected to address the Ebola outbreak. But it also leads clinics to close and for people to be less likely to come into a health facility because they're afraid that they might get Ebola there. And with the West African outbreak of 2014 to 2016, there were studies looking at, you know, what were the rates of indirect deaths in Guinea, where I actually spent two months working as an Ebola aid worker at the time. There were more indirect deaths than there were from Ebola.

29:07And some of the specific diseases that get worse include TB and HIV, And this is partly because those require uninterrupted daily therapy. TB treatment runs at least six months. HIV treatment is lifelong. And when somebody stops their medications, that puts them at risk for developing drug resistance, relapse, transmission to other people. Childbirth is also a very high risk period, whether a woman has Ebola or not. Ebola in pregnancy is really deadly, both for mother and baby. But even if she's not infected, if it's just a regular pregnancy, you can't reschedule a woman going into labor. And if she has obstructive labor, she has hours, not weeks, for somebody to intervene.

29:57And many of these women are not coming in to deliver in a health facility, which means that if there are complications, their risk of dying in childbirth increased dramatically. Jeremy, are there places where you are seeing lessons from past outbreaks being applied in the DRC? Yeah, I think the challenge they're facing right now is very similar to the challenge we faced in the early phases of the 2014 outbreak, which was the expansion of the outbreak is exponential, and the expansion of the response is linear right now. The UN has said that they need to triple the scale of the response that they have right now to hope to keep pace with the rate at which the outbreak is expanding.

30:45And we learned some things about what you can scale and what you can't. It's very hard to rapidly scale up Ebola treatment center beds because that is very, very labor intensive and capital intensive. But things like burial teams and the example that Matt gave of this burial team rapidly swooping into action to safely care for and handle that recently deceased man, that is critical because the super spreading where you can get one case turning into 25 or 50 is often through unsafe burials. So if you can get on top of the unsafe burials, that is a huge step towards moving from exponential spread to merely linear spread, which becomes a lot easier to contain.