'Race against time' to contain Ebola outbreak in central Africa

As tidings bust of an Ebola irruption in the popular Republic of congo river over a week ago, Jason Kindrachuk felt optimistic, knowing the competence of the local responders and health-care workers he's previously worked with on the ground.

But in recent days, the Canadian microbiologist says his optimism about containing the outbreak has faded. 

There are now more than 1,000 suspected cases and hundreds of deaths, mainly across northeastern Congo, along with seven in neighbouring Uganda.

Scientists suspect the true tally is far higher, as the outbreak was likely growing for weeks or more before global health officials became aware. It’s also linked to the relatively rare Bundibugyo form of the Ebola virus that doesn’t have any approved treatment or vaccine.

"The faster we can identify suspected cases … the faster that we can try to get things contained."

On Monday, the World Health Organization’s director-general echoed that sentiment. 

During a virtual briefing with African officials, Dr. Tedros Adhanom Ghebreyesus said the delay in detecting the outbreak means teams are "now playing catch-up with a very fast-moving epidemic" that he expects will "get worse before it gets better."

The challenges facing health-care workers are immense.

Alongside the lack of a vaccine to prevent new infections, there is also intensifying violence in Congo’s embattled Ituri and North Kivu provinces and significant distrust of outside authorities. Tensions flared up during multiple recent incidents, including fires set at health-care facilities and dozens of Ebola patients fleeing treatment sites.

"We are urgently scaling up operations," Ghebreyesus said, "but at the moment, the epidemic is outpacing us."

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Kindrachuk and other Canadian experts with personal experience tackling Ebola say the path forward will be rocky.

This is a much more complex situation than other recent Ebola outbreaks, said Kindrachuk, who worked in Liberia during West Africa’s massive 2014 epidemic of the Zaire form of the virus, which led to tens of thousands of infections over a period of more than two years. 

There was no vaccine at that time, either. But as a result, the current Ebola shot is tailored to the Zaire virus.

Efforts to test experimental vaccines for the current outbreak are now being scaled up, including a shot developed out of Oxford University that is loaded with genetic code from the Bundibugyo Ebola virus, according to media reports. But it won’t happen overnight. 

Canadian vaccine researcher Darryl Falzarano, who has previously worked on antiviral strategies for Ebola, said there’s frustration among scientists that there aren’t working, approved vaccines for non-Zaire forms of the virus given the science is already there. 

"It's not a technological reason," Falzarano said. "It’s a societal, financial reason."

At a basic level, the logistics of tracking infections and moving workers and supplies through Congo are fraught given the country’s massive size and ongoing conflict. 

"That's led to a lot of people that have been internally displaced," said Kindrachuk.

"As we have people that are moving out of these zones where there are infections or circulation of disease, it becomes harder to track, right? All these pieces are conflating together to make things much more difficult."

Speaking from his own experience, Kindrachuk said remote regions of Congo can be tough to reach, since there are vast swathes of land without paved roads. He recalled one trip that involved treating malaria, where a short journey from the Congolese capital Kinshasa actually required a perilous, days-long journey.

In Congo’s Ituri province, the epicentre of the current Ebola outbreak, nearly five million people live amid ongoing conflict, according to the WHO.

Health and humanitarian workers are among those fleeing violence in the region, the organization said, which is "severely impeding efforts" to identify infections early enough to provide supportive care.

Dr. Rob Fowler, a Toronto-based critical care physician at Sunnybrook Hospital who has helped with prior outbreaks in Congo, Guinea, Liberia and Sierra Leone, stressed that instability also leads to daily interruptions in contact tracing — the efforts to track down people who could be potentially infected by the virus, which is highly contagious through bodily fluids.

Africa's climate is also challenging to work in, given the need for constant personal protective equipment, he said. Fowler has helped push for PPE that's made to be reusable and equipped with fans to cool workers down — otherwise, he said, it's impossible for teams to care for patients for long periods of time.

There was huge risk to teams working on the ground in the pre-vaccine era of 2014 and major reliance on personal protective equipment, Kindrachuk recalled. "We’re back into that … we need to ensure we can get folks tested diagnostically if there’s any issue and get them out to care if they do show any symptoms."

Underpinning those challenges? The public health infrastructure is limited to begin with, Fowler said, relying upon resources from international partners to shore up diagnostic testing and safe care.

"And over the last couple of years, there’s been a lot less international support and aid."

Senior Health & Medical Reporter

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