Hospitals overwhelmed: the most serious Ebola outbreak in years overwhelms Congo

BarcelonaThe Ebola outbreak detected in the Democratic Republic of Congo has been collapsing hospitals in the northeast of the country for days. With 177 suspected deaths and 750 cases also under scrutiny, in addition to currently undetermined but seemingly high detection rates, it is positioning itself as the third most serious outbreak in the history of this virus, and for now it is far from being controlled. The variant, named Bundibugyo, had only been detected on two occasions, in 2007 and 2012, and although it is not clear if it is more contagious than others, the conditions in which the outbreak has occurred lead to fears that the figures for cases and deaths will escalate in the coming days and that it will be complicated to stop the spread of the virus.

who has shown "deeply concerned" by the outbreakwho has expressed "deep concern" about the outbreak, has declared international health emergencythe virus has been circulating and has not been detectedthe virus has been circulating and undetected. One of the first identified cases was that of a nurse in Bunia, the capital of Ituri, which suggests that she may have contracted it while caring for patients in whom the virus was not detected. The epicenter, however, is believed to be about 90 kilometers away, in the city of Mongbwalu.

If the Congo is a country accustomed to Ebola outbreaks – this is the 17th outbreak it has faced since 1976, when the virus was first detected – why has it taken so long to confirm that it was circulating again? Beyond factors such as high mobility in the region and limitations in access to health services, the variant has also played a role. "The Bundibugyo is a variant with which diagnostic systems do not work properly," explains Javier Martínez-Picado, ICREA researcher at IrsiCaixa. Since it is an unusual variant, these systems are not as reliable in detecting it as they are with others. "Initially, some diagnoses gave false negatives or indeterminate results, and this has delayed detection," details Martínez-Picado.

The delay in detection has led to a high spread, and has caused an ever-greater collapse of hospitals, especially in the province of Ituri. "The isolation units are full, and people cannot come to hospitals to receive treatment," explained this Thursday Florent Uzzeni, emergency coordinator for Doctors Without Borders (MSF) in the Congolese province of Ituri, in statements to the press. In addition to a lack of space, medical supplies are also scarce, and the particularities of the province, located in a remote area in eastern Congo with an already complicated humanitarian situation, hinder the arrival of material and personnel.

"We are trying to set up specific Ebola treatment centers as soon as possible," Manuel Albela, MSF's epidemiology advisor, tells ARA. "These are structures that operate separately from hospitals to decongest them. All patients suspected of having Ebola who need to be isolated are diverted to these centers, where we have specific materials and resources," explains Albela, who warns that the current situation is reminiscent of the first weeks of the 2014 epidemic, the worst in history, which caused 11,325 deaths. At that time, the epidemic, which in that case particularly affected Guinea, Sierra Leone, and Liberia, lasted two years and was caused by the Zaire variant.

Less mortality but no vaccines

Among the few things that offer some hope to experts is that the Bundibugyo variant is one of the least deadly, at least based on its behavior in the 2007 and 2012 outbreaks. The mortality of this species of the Ebola virus is around 30%, and it aligns with the figures from the current outbreak. In contrast, the Zaire variant is the most lethal, causing the death of between 60% and 90% of patients who contract the virus. However, the optimism that this fact might generate is overshadowed by the number of suspected cases being identified. "We have never seen so many cases of Ebola of the Bundibugyo variant, nor have they ever appeared so suddenly," warns Albela.

However, in addition to the delay in detection and the particularities of the area where it has been declared, the outbreak is also concerning because there are no vaccines or antivirals for the Bundibugyo variant. So far, more clinical progress has been made in addressing other more frequent variants like Zaire, responsible for the majority of Ebola outbreaks throughout history, including the 2014 one. According to the WHO, two vaccine options are being studied, but they are still far from being authorized: one is on the verge of clinical trials in humans, and the second has not even been tested on animals. At the earliest, the United Nations agency estimates a timeframe of between six and nine months to achieve emergency authorization.

Fewer resources for the US withdrawal

On this occasion, the international community faces an additional challenge in addressing the spread of the virus and advances in scientific research: the withdrawal of the United States from the WHO, which began to be effective this January, and the budget cut for development and humanitarian aid programs, also driven by the White House. "The WHO has the capacity to act, but it is indeed weakened because Washington is not actively contributing," portrays Martínez-Picado.

Although it has been speculated about the possibility that this new situation has influenced the delay in identifying the outbreak, most experts in the sector assure that it is still too early to establish a cause-and-effect relationship, but they agree in pointing out that the reduction in budget and resources for prevention and scientific research increases the probabilities that an epidemic like the current one gets out of control.