This week we talk about the Democratic Republic of the Congo, malaria, and healthcare infrastructure.

We also discuss militants, Uganda, and the Bundibugyo virus.

Recommended Book: We Should Get Together by Kat Vellos

Transcript

Ebola, which is more formally called Ebola Virus Disease or Ebola Hemorrhagic Fever, is caused by an infection by a type of RNA virus called an orthoebolavirus.

There are six known species of orthoebolavirus, and four of them have at some point infected and caused illness in humans. Those four are the ebola virus, sometimes called the Zaire ebolavirus, which historically has been the strain responsible for the biggest, most devastating outbreaks of this disease, the Sudan virus, the Taï Forest virus, and the Bundibugyo virus, the latter three each causing a variant of the disease that carries the same name.

The other two orthoebolavirus species that we know of, the Reston virus and the Bombali virus, have been known to infect animals, but have not, at this point at least, been known to make the jump to human hosts.

Ebola symptoms vary a bit between specific viruses and between hosts and infection conditions, but in general those who are afflicted by ebola begin to experience symptoms between a few days and a few weeks after infection, and they’ll start by experiencing cold and flu-like symptoms, like fever, sore throat, headaches, and general muscle pain. Soon after that, though, they’ll start experiencing diarrhea and rashes, they’ll begin vomiting, and they’ll begin to experience liver and kidney dysfunction, and around that same time, they’ll start to bleed internally and externally.

Once infected, a person has between a 25 and 90% chance of dying, depending on the strain of ebola, and if they die, usually due to what’s called hypovolemic shock—a severe and sudden loss of bodily fluids, including blood—they usually die between 6 and 16 days after those first symptoms are reported.

What I’d like to talk about today is a new outbreak of ebola centered in the Democratic Republic of Congo, and why this one stands out from other recent outbreaks in the region.

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Ebola was first officially reported in medical literature in 1976, mostly in sub-Saharan Africa, and there have been semi-regular outbreaks in that region, of various sizes ever since, and very likely before that, too.

This disease is spread through direct contact with the body fluids of someone who’s infected, and it’s thought that this is probably how the disease made the leap from animals, like primates, to human beings: locals sometimes come into close contact with local primates, either while just coexisting, or while hunting bushmeat, hunting monkeys for food.

It’s thought that fruit bats serve as hosts for the virus, long-term, and it then spreads to other animals, and then sometimes to humans, in some cases causing illness along the way in those other species, but not always; bats are not negatively afflicted by it, for instance, but humans very much are.

Despite not being an airborne pathogen, so it’s not spread by coughing or talking too close to someone, like a cold or Covid-19, ebola can still be spread person-to-person through bodily fluid contact. That means fluids like saliva and blood and semen and breast milk, and research has shown that even after someone survives and recovers from ebola, the disease can linger in their fluids for months. So if someone catches it, survives, and then breast-feeds their child, or kisses or has sex with their partner, or gets a cut and then someone else comes into contact with their blood, like a health worker, that can lead to the transmission of the disease, despite their having been well and seemingly fully recovered for weeks or months.

That lingering contagiousness is a confounding factor with this disease, as it requires that people be very careful, even to an antisocial degree, and even well after it seems like that’s no longer necessary, because they feel good and healthy again.

This also means that if someone dies of ebola, contact with their bodies can be incredibly dangerous. And past outbreaks have stemmed from or been further enflamed by locals wanting to perform community funerals and wakes, during which the body is often on display and touched by attendees, and that has led to further spread of the disease—which in many cases is difficult to tie back to that wake, because again, symptoms don’t arrive right away, and ebola symptoms are similar to what locals experience all the time from other afflictions, like colds and malaria.

This past week, in Bunia, which is located in the Democratic Republic of the Congo, locals stormed a regional hospital in an attempt to recover the body of a beloved local figure who died of ebola. In the process, the hospital’s isolation ward, which was being used to keep ebola victims separate from everyone else, to keep the disease from spreading further, that ward was burned to the ground.

There are no vaccines or treatments for the Bundibugyo Ebola species that is at the core of the outbreak, and the spread of misinformation in the area had locals believing that these health workers were trying to kill their patients, not save or isolate them so no one else caught ebola.

The man at the center of this, who died five days after being admitted to the hospital, was thought, by his family, to have malaria, which is common in the area and has very similar symptoms, at least in the early days of an ebola infection.

They demanded the hospital release his body so they could bury him, and the staff refused, saying doing so right now could lead to more ebola spread. The family gathered more locals, who threw stones at hospital workers, they broke through the gates of the hospital, police fired into the air to try to disperse the angry crowd, and the ebola ward caught fire during the melee. During that fire, five patients who were in the ward, all suspected of having ebola, fled, and they haven’t yet returned—so they are possibly out in the open, no longer isolated, suffering and maybe dying from their infection, and possibly spreading it to others, as well.

There’s a lot going on in this story, and misinformation spread by local traditional healers who don’t like the hospitals and the medical workers who tell locals medical information rather than folk healing information are part of the problem, but the local medical establishment not doing a good job of educating locals about what they’re doing and why are arguably the flip side of that same coin; more investment in that kind of information dissemination by the government would go a long way to preventing this sort of thing in the future, and health workers globally could use more resources and overall infrastructure to help protect them while they’re carrying out their work.

That said, this is just one small facet of what’s become a much larger story. As of the day I’m recording this, this new outbreak, which was first reported in the Ituri Province of the DRC, has caused 186 confirmed deaths, with 82 more confirmed cases and 836 suspected cases.

As I mentioned, it’s caused by the Bundibugyo ebolavirus, which is less common, at least at this scale, and thus typical response efforts used against the more common Zaire ebolavirus, don’t seem to map onto this strain as well as was hoped, and the World Health Organization declared a Public Health Emergency of International Concern on May 16, as while this is unlikely to become as significant an issue as Covid-19 or other aerosol-spread infections on a global level, regionally it’s causing a lot of damage, and its nature, and the state of international aid for this sort of thing—which is currently substantially reduced, in part because of pullbacks on such programs by the current US administration—means it could continue to flare for several more months, before eventually starting to slow, killing many, many people, in any incredibly painful and contagious manner, in the process.

This is the 17th ebola outbreak in the DRC since the disease was first recorded in the medical literature, and the third outbreak of this strain—the first of which was in the Bundibugyo District of Uganda in 2007 through 2008, that’s where it got its name, and then another in 2012 in the DRC.

This isn’t the deadliest strain of ebola, only killing between 25 and 50% of those afflicted, but because of those aforementioned issues, plus it having flared in a region where governance is complicated by the presence of several militant groups, this wave of infections has created a broad and precarious situation; lots of people have been uprooted from their homes because of conflict between these militant groups and the government, and those refugees have been spreading ebola to other areas throughout the region, making contact tracing difficult or impossible, and leading to surges of new infections in neighboring, and a few further-flung, provinces.

According to a predictive model of the outbreak published by the MRC Centre for Global Infectious Disease Analysis, the current number of infected people could actually be well over 1000, in part because of how difficult it’s been isolating the infected, and because the early symptoms are so similar to other common local afflictions; so people are less likely to visit hospitals and get an accurate diagnosis, because they assume it’s just a bout of something else, something less deadly and contagious.

Getting resources into the area is becoming more difficult, too, as those militant groups are fairly active, one such group recently taking over a primary regional airport, which has disallowed the import of necessary medical equipment for regional hospitals.

This hasn’t had ...