Major Ebola outbreak is escalating: what happens next

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1:05Hi listeners, Benjamin here. Welcome to the Friday edition of The Nature Podcast. Now, normally this would be the briefing chat show, but we're changing things up again this week. There is currently an outbreak of Ebola, centred in the Democratic Republic of the Congo, that has been declared a public health emergency by the WHO. It's been caused by the rare Bundibujo species of Ebola virus, and researchers and public health professionals are scrambling to get on top of it. At time of recording, the outbreak has been linked to around 140 deaths and around 600 suspected cases, numbers that are likely to rise in the coming days.

1:43To get the background on this outbreak and the efforts to tackle it, I'm joined by Rachel Fieldhouse, one of the team here at Nature covering this evolving story. Rachel, thanks for being here. No, thank you for having me. So let's talk about what Ebola is, because hearing that name can elicit a lot of responses that are not necessarily grounded in reality. Now, clearly, this is a very serious infectious disease and one that's caused by a group of viruses. That's right. So there's four of these ortho-Ebola viruses that can cause infections in humans. Some of the general symptoms, they start off quite nonspecific.

2:19So people present with fever, body pain, weakness, vomiting. So very flu-like. That's part of the issue when it comes to identifying someone with Ebola virus. But then also some of the more serious symptoms include things like significant bleeding. And the Ebola virus is generally spread person to person through contact with bodily fluids like blood, saliva. And also we can have transmission on contaminated surfaces. And that's why we sometimes see spread in healthcare settings. And so with this Bundy Bujo species in particular, it can generally have a mortality rate of about 25 to 50%. That's based off some previous outbreaks that there's been two, one in the Democratic Republic of the Congo and another in Uganda.

3:09And this is perhaps what makes this current outbreak so unusual. As you say, this is just the third outbreak on record involving the Bundy Bujo species. Most other outbreaks have been caused by what's known as the Zaire species. What do we know of the timeline of this particular outbreak involved in this Bundibujo species? So from what we understand, it seems like there was a initial patient around A-20, so a healthcare worker started to report symptoms of fever, muscle pain, generally feeling unwell. That person then later died. And then the WHO suspects that then there was a super spreader event.

3:49That seems to be our understanding so far. Authorities aren't quite sure when the spillover event was, like who was the person to come into contact with an animal, particularly like a fruit bat or a non-human primate. And we don't know when it first started to spread. And this initial patient, this healthcare worker, they're the first person that we know about where they're not going to be patient zero because they probably got it from a patient they were treating. And as of the information we know right now, then, this outbreak is currently in two countries, so the Democratic Republic of the Congo and Uganda.

4:22And the WHO have subsequently categorised this as a public health emergency of international concern. What does this mean in real terms for response to this outbreak? Really, it means that there needs to be a serious response. So it's about alerting non-government organisations, other countries, other public health bodies to really pay attention to what's happening to try and help figure out how this virus is spreading and try and stop the outbreak because it seems like based on some initial modelling that potentially a thousand people are already infected and this outbreak could easily get out of control and spread to other countries.

5:01So it's really not trying to cause panic, it's trying to get people to pay attention and assist with controlling the outbreak. Right, because this recent modelling exercise by an international team that was released a few days ago suggests that the true number of infections could be vastly higher than those reported. Potentially, as you say, over a thousand people are already infected, although of course this is a modelling exercise. And in terms of numbers, one of the issues here is that the incubation time for this virus can be quite long, right? Like you don't necessarily know if someone's been infected potentially for quite a while.

5:35That's right. So it's between two and 21 days. Another challenge is that, like I said earlier, the symptoms are non-specific to start with, so they can easily be misdiagnosed as another illness. In this part of the Democratic Republic of the Congo, the Eturi region, they also have concurring outbreaks of Bampox, measles, also malaria and malnutrition can easily mask these kinds of initial symptoms. So clinicians are faced with a very tough challenge of trying to figure out exactly what kind of illness patients can present with. And you're right, of course, there are multiple pressures for healthcare staff in this region.

6:13But also it has to be noted, there is armed conflict in this area as well, which means folks are being displaced as they, of course, look for safety. Now, all of these things are likely to hamper efforts to get on top of this outbreak. But there's also the fact that it is this Bundy Bujo species involved. Because this is so rare relative to what we know about Ebola outbreaks, this complicates things in terms of testing and treatments because it is an unusual species. Right. So a lot of the field tests that are used to detect Ebola don't actually test for the Bundy Bujo species. They test for the more common Zaire species.

6:49So that was another challenge. And then also for the Bundy Bujo species, there's no specific vaccines or therapeutics. So if someone is ill or infected, they generally just have to receive supporting care as they fight the infection. And in terms of things like vaccines, there is a vaccine against the Zaire species. But as you say, it's not the same thing. And researchers are obviously racing to try and develop a vaccine that may be efficacious against this species. What do we know about that? So currently, there is a vaccine under development, but unfortunately, it's not at the clinical trial stage.

7:23So we're not likely going to be seeing it tested in this outbreak. What is potentially going to be tested are some therapeutics or some kinds of drugs to help people fight the infection when they've already been exposed. So the first one, something probably people have already heard of before is remdesivir. So it made an appearance during COVID and it's a broad spectrum antiviral. And it's also has been trialed against the Zaire species of Ebola. And that trial is pending approval, but we might see that tested during this outbreak. We might also see a drug called MBP134. So it's a mix of two antibodies.

8:01And that has already been tested before, but it was for a different species. And it was administered under compassionate use, not a clinical trial. So that means that doctors would have to appeal to essentially get permission to use this kind of drug for someone who's very unwell. And generally, they don't have a lot of other options. We've seen this for other drugs and other treatments that haven't made it to the clinical trial stage yet. So we don't know what safety information there is. But it looks promising and it's essentially a last resort for people who are really, really unwell. Obviously, therapeutics, obviously vaccines will hopefully ultimately reduce the impact of this outbreak.

8:39But public health officials in these countries have experience of Ebola outbreaks. They know how to get on top of these things. And good old fashioned epidemiology is part of this. What have folk been telling you? They've been telling me that epidemiology is potentially one of the ways to really get this outbreak under control. So basic, potentially not as exciting things as new therapeutics. So contact tracing, isolation of people who are potentially infected or suspected to be infected, and then also disease surveillance. Those are the things that could really help potentially limit the spread as well.

9:10And also even things like public communication. So telling the public, this is what Ebola looks like. These are the symptoms to look out for. This is what to do if you think you're unwell. And this is what you shouldn't be doing. It'll be those kinds of messages that would also be very important. And I guess the great unknown here is where this outbreak goes. As we've said, there have been some terrible outbreaks in previous years. The 2014 to 2016 outbreak infected almost 30 ,000 people and killed more than 11 ,000. Now that was the Zaire species of Ebola and the initial reports of that outbreak were of a much lower number of cases that have been seen this time round.

9:49What are the thoughts about the potential for this outbreak? People have been very concerned with just the sheer number of people who have both been confirmed as infected or suspected to have been infected and also the number of people who have died. So that's led officials to really think that this has been circulating for a lot longer than we thought. At the moment, people are thinking it's been circulating for at least two months undetected. And the risk here is that there is a lot more of the virus out there in the community and that that's going to make it quite hard to bring this outbreak under control.

10:23So it seems like, at least for the moment, it's still a lot of fact finding, a lot of looking for people who are infected and trying to get them isolated and contact tracing. So really, it's a scenario that we're not quite sure what will happen next. And it's yet to be seen how large this outbreak will be, whether it spreads to more countries. There's a lot of unknowns. Of course, researchers and public health officials are scrambling to help people and figure out more about these unknowns. What of the folk on the ground in the DRC, Rachel. Again, you've been speaking to folk who are on the front lines.

10:58Yes. I've spoken to an intensive care doctor who has gone into the Democratic Republic of the Congo to assist with the public health response that's being run by the Ministry of Health there. He has responded to previous outbreaks of Ebola. And he was saying that there's a real sense of frustration. And part of that is because the outbreak was detected so late. And there's a few reasons that that could be. He was saying that disease surveillance is very week in the area. He was also saying too that one of the big impacts and one of the sources of frustration is the lack of funding and resources.

11:33And part of that is from the US withdrawing aid. So that kind of funding was used for disease surveillance and responding to outbreaks. It's also made it very hard for doctors and public healthcare workers to open facilities to isolate people, which means that it's a lot harder to contain the spread if you can't separate people who are infected from non-infected people. And really, it's really tough for people on the ground. They're working with the resources and logistics they have, but he was saying there's a real need for more and more support, more expertise, but that all costs money. And when I was speaking to this doctor, there was one thing that really struck me and really stood out when we were talking about whether this outbreak could be contained, whether it was too late.

12:15He was really saying, we don't have a choice but to control this outbreak. It was the same for previous outbreaks, you can't just let these infections and these viruses spread and kill so many people and make so many people sick. It's a matter of necessity. And public healthcare workers, really, they put themselves at risk. And epidemiologists put themselves at risk. All of these people involved in the response are willing to do that in order to curb the spread, stop the outbreak and make sure it's under control. Well, let's leave it there, Rachel. Rachel, we'll put links to all of your articles and all of Nature's other news articles on this evolving story in the show notes.

12:54Or listeners, you can head over to nature.com slash news to read them there. But for the time being, Rachel Fieldhouse, thank you as always for joining me today. Thank you so much for having me.

13:1782%. Less manual work, clearer visibility, faster deals, zero chaos. Call it compliance or call it compliance. Get it? Join the 15 ,000 companies using Vanta to prove trust. Go to Vanta.com slash com. You stopped waiting for permission and started building yourself, your dreams, your credit. Experian Boost could turn your on-time payments into instant FICO score gains. every bill you paid could become proof of your power self-made absolutely self-funded experian could help you get there download the experian app today results will vary not all payments are boost eligible some may not see improved scores or approval odds not all lenders use credit information impacted by experian boost see experian.com for details