Whenever you hear about an outbreak of Ebola, it is frightening, and the current one in the Democratic Republic of Congo is particularly troubling. There have been hundreds of cases and dozens of deaths in the country, plus spread into Uganda, making it one of the largest outbreaks we’ve ever seen.
New modeling from the US Centers for Disease Control and Prevention suggests this outbreak could even surpass other historic outbreaks if strong public health interventions are not rapidly implemented.
At this time, the regional risk is high, but the World Health Organization has maintained that the risk to the broader global community is low. For many of the reasons outlined below, there is a nearly zero chance this becomes a pandemic.
At a CNN All Access Subscriber Series event this week, I spoke with CNN Chief International Correspondent Clarissa Ward about the situation on the ground and Dr. Jay Bhattacharya, director of the US National Institutes of Health and acting director of the CDC, about how the US is responding.
Here’s what I want you to know about this outbreak.
We lost weeks, maybe months, in the fight against this
WHO officially declared this Ebola outbreak a public health emergency of international concern on May 17, about two weeks after the agency says it learned about a high-mortality outbreak of unknown illness in the Ituri Province of the DRC.
But health officials now generally agree the disease was probably spreading long before we knew — perhaps as early as February.
The mayor of Mongbwalu, a remote gold mining town in Ituri Province, told Clarissa that he thinks the first case was on February 22. Around that time, a body was moved out of a local morgue, and a coffin was burned. Within two weeks, dozens of people in the town were dead, Clarissa told me.
At first, local leaders thought tuberculosis may have been driving the deaths. They also tested for Ebola, but those early tests came back negative because they were looking for the more common Zaire strain of Ebola, not the Bundibugyo strain that’s behind the ongoing outbreak.
WHO officials are investigating to learn more about the timeline of spread, which they also concede probably started earlier than they knew.
As the WHO regional director for Africa put it, “in an outbreak, time lost is transmission gained.”
New CDC modeling poses many scenarios in which the current outbreak could become larger than the 2014-16 outbreak in West Africa in a matter of months. That outbreak resulted in more than 28,000 cases and more than 11,000 deaths.
We know there have been at least 60 deaths in the current outbreak. But if the ongoing investigation shows that there were more – 100 or even 200 deaths by late May – the modeling predicts a much higher likelihood of this growing into a massive outbreak. The best chance to minimize that risk is to identify and isolate cases as quickly as possible.
Any Ebola outbreak is complicated. This one is extraordinary
Ebola is not very contagious — contrary to what you may have heard, it doesn’t spread easily, like measles, or even Covid-19 — but it is an exceptionally infectious disease.
What that means is that an infected person has to be very sick with a lot of virus built up in their body before they would be able to spread it to another person. But once a person reaches this stage, a week or so after infection, it takes only a small amount of bodily fluid to potentially cause an infection in someone else.
For this reason, healthcare providers and family members or other caretakers are the most likely to contract it. In this current outbreak, most patients are women and between the ages of 20 and 39.
Personal protective equipment, or PPE, like masks and gloves can help prevent spread. But the outbreak in the DRC is happening in a remote place with limited resources.
Conditions are improving as international partners surge resources to the area, but for weeks, hospitals wards have been overwhelmed with patients and far from enough equipment to care for them – or healthcare workers – properly.
I saw firsthand how difficult it is to manage the disease when I went to Guinea during an Ebola outbreak there in 2014. You must be extraordinarily careful; even small breaks in the skin around your fingernails can make you susceptible when exposed.
One of the most important ways to get an outbreak under control is contact tracing, which can help break chains of transmission by identifying people who might have been exposed. But this core public health strategy is extremely difficult in the DRC.
WHO said this week that it aims to reach more than 90% of contacts to get ahead of the outbreak. So far, it has reached less than half.
Violent conflict in the area causes a lot of insecurity and displacement in the community. Local residents also have a deep mistrust of hospitals and aid workers; some don’t believe that Ebola is real and see hospitals as places people go when they’re sick but never return from. This can make it hard to gather information or implement precautions even when you reach a contact.
The US has long planned for how to handle Ebola cases here
One American has been infected with Ebola in the current outbreak: Dr. Peter Stafford, a missionary physician who was working in the DRC.
He is being treated in Germany while the US is working to stand up a facility in Kenya for Americans who may have been exposed to the virus. But Dr. Bhattacharya told me that he’s not ruling out the possibility for some patients to return to the US for care, depending on their specific circumstances.
The US has a network of federally designated treatment centers that are specifically designed to handle emerging special pathogens such as Ebola. Some isolation rooms at the University of Nebraska center are currently occupied by people who are being monitored for hantavirus. The Emory University Hospital in Atlanta successfully treated multiple Ebola patients during the outbreak in 2014.
There are no specific treatments for the strain of Ebola driving the current outbreak, but early medical care can make a big difference.
Early signs of illness can include “dry” symptoms such as fever, achiness and fatigue. As the illness progresses, “wet” symptoms including diarrhea, vomiting and unexplained bleeding may occur.
Just giving fluids and replacing electrolytes can be lifesaving. Patients may also receive medicines to manage their blood pressure and minimize other symptoms.
There are also a couple of experimental therapies that are promising. Those include two monoclonal antibody products, which use protective proteins that are generated as part of the body’s immune response to target diseased cells.
Some of these experimental monoclonal antibodies were shipped overseas so that the American doctor could be treated with them while on his way to additional care.
It will be months before we start to have answers on treatments and vaccines
During the Ebola outbreak in West Africa from 2014 to 2016, a vaccine was developed, trialed and eventually cleared by the US and other countries in Europe and Africa for official use.
But it is targeted to the more common Zaire strain of Ebola, and there’s limited information about how well it would protect against the current outbreak’s Bundibugyo strain — as well as unknowns about its safety.
There are three vaccines in development that would specifically target the Bundibugyo strain: A vaccine being developed by Moderna and one from the University of Oxford with the Serum Institute of India could be ready for clinical trials in two or three months, while the third from IAVI will take at least seven months.
The data available for these vaccine candidates varies; some do not have animal testing data, while others have had promising findings in nonhuman primates, but clinical-grade material for testing in humans is not yet available.
A group of independent advisers to WHO also identified the oral antiviral obeldesivir as a priority candidate for development, which would be an option to offer to contacts of confirmed and probable cases as contact tracing ramps up. WHO officials said it could be available through clinical trials within a few weeks.
The risk in the US is low, even during the World Cup
Infectious diseases are always a concern in large gatherings, including the World Cup that is expected to bring millions of travelers to North America this month. Ebola is well within the scope of possible threats that officials have prepared to respond to, but experts say that it’s unlikely to pose a threat.
A person with Ebola who is sick enough to be contagious is probably not well enough to get out of bed, let alone attend a sporting event. Many symptoms are obvious: They’re often feverish and vomiting and may even be bleeding.
In these giant events, the risks you’re more likely to encounter are the ones we all know: heat, dehydration, bugs and other run-of-the-mill viruses spreading everywhere all year long.
The US has coordinated special airport protocols for travelers coming from the area affected by the outbreak. Passengers traveling to the US who have been in the DRC, Uganda or South Sudan in the previous 21 days must land in Atlanta, Houston, New York’s John F. Kennedy airport or Dulles airport outside Washington for health screenings.
The CDC has also developed a World Cup data dashboard, and the agency says it has tools that can assess the potential risk of an outbreak and identify unusual patterns in surveillance data in near real-time.
And earlier this month, the National Center for Health Security and Resilience – a joint effort between Georgetown University and MedStar Health – launched the Health Security Operations Center, an independent, collaborative hub for monitoring potential infectious disease threats. The center will distribute daily situation reports to organizations and individuals, including hospital emergency managers, state and local health officials, federal agencies and tournament organizers.
An Ebola threat is rare, but public health leaders say that responding to it is the “bread and butter” of their work.
The first time an Ebola patient was treated in the United States was in 2014. Now, given the nature of global travel and the fact that the virus has an incubation period as long as 21 days, it is possible we see patients with Ebola once again in the United States. Caring for those patients in the US did not lead to an epidemic then, and it is incredibly unlikely to happen now.
Here’s what I want you to know: There’s a global public health effort that’s designed to handle threats just like this one. The best way to protect yourself and the people around you from things like Ebola is to stay informed.
CNN’s Deidre McPhillips contributed to this report.
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