Congo Ebola outbreak could have gone either way

In a welcome announcement on Tuesday, this week the worrying Ebola outbreak in the Democratic Republic of Congo (DRC) was officially declared over by the country’s Health Minister, after 42 days with no new cases of the disease identified.

This was very good news as the three month long outbreak could very easily have exploded into a lengthy, full-blown epidemic in both Congo, and perhaps a number of neighbouring states.

Two opposing sets of factors were in play in Congo. One, a range of ‘negatives’ that could have very easily led to a major, deadly epidemic, the other a number of ‘positives’ that offered some optimism that the calamitous West African Ebola experience of 2013-16 might be avoided.

The potential for an alarming spread of the outbreak was quickly realised by the World Health Organization (WHO). In May, in the early weeks of the outbreak, the Organization in various pronouncements warned that the risk to public health in the DRC was very high and the risk of international spread to neighbouring countries also high. On the virus reaching the densely populated port city of Mbandaka it was warned that the disease could now spread exponentially.

That these developments never came to pass was a fortunate break as many of the conditions favouring a calamitous epidemic in a country with one of the world’s most fragile health systems were only too easy to see.

Logistically the outbreak posed very difficult challenges. Tracking down people suspected of contact with infected persons, particularly those in remote rural areas, was a daunting task. Poor roads through often densely forested terrain made access to such communities especially difficult. The movement of people in turn compounded the difficulty of contact tracking. The need to monitor vaccinated contacts for three weeks was a further challenge.

Weak technological infrastructure was a further issue. Cell phone and internet coverage limitations for example, made communications and coordination between health workers difficult. Added to this was the lack of electricity in some affected areas, posing difficulties for establishing the ‘cold chain’ capacity (i.e. between -60 and -80o C) necessary for safely transporting and storing vaccine supplies.

The threat of the outbreak spreading down the Congo River from Mbandaka to the capital city Kinshasa was a significant risk with the high volume of barge traffic plying the river. Once within the megacity of 11-12 million residents just one case of the disease could have set off a deadly epidemic with contact rates multiplying exponentially and the ability to identify and track such persons more difficult than in small rural communities.

On gaining a foothold in Kinshasa, bringing the disease under control would have taxed the global health community’s abilities.

As in the 2013-16 West African epidemic, suspicion (and avoidance) of health workers also had to be confronted and overcome. Likewise, dangerous cultural beliefs and funeral practices raising the risk of infectious spread.

Fortunately, despite all these factors favouring the outbreak exploding into a major epidemic those worst fears never eventuated.

In this regard, lessons learnt from the West African epidemic were pivotal.