News of Ebola re-emerging in West Africa last week on top of the global coronavirus pandemic makes for the perfect toxic mix. West African countries are contending with the pandemic in various ways, with outside help from Europe, the US, China and Russia.
It is important to recall the last major Ebola incident. The 2013-2016 West African outbreak was the largest, most severe and most complex Ebola epidemic the world has ever seen, killing 11,300 people. A small number of cases were reported in Mali, Nigeria, Senegal and the Democratic Republic of the Congo (DRC), but these countries intervened early and effectively to limit disease transmission. A handful of cases were reported in countries outside of Africa, including Spain, the UK and the US.
Now, with a new Ebola outbreak in the DRC and Guinea, there are fears of a compounding of problems for these countries and the region as a whole, with the coronavirus disease (COVID-19) already omnipresent.
The mix of the two diseases illustrates how pathogens emerge simultaneously and why the global community is making disease monitoring and maintenance such a key priority. Just as with COVID-19, gene sequencing of Ebola samples from both the DRC and Guinea is being carried out to learn more about the origins of the outbreaks and to identify the strains.
So far, the news is positive, in that this outbreak is not an Ebola mutation. The DRC has confirmed that its latest cases are not linked to a new Ebola variant. Instead, preliminary analysis shows the resurgence to be the 10th outbreak — the second-largest on record, which caused more than 2,200 deaths in 2018-2020. This means that, with only a one-year gap, the re-emergence of Ebola signals that the disease did not fade away. There is another factor: The Ebola outbreak is occurring in an area with daily violence, compounded by instability. Militias and terrorist groups increase the mistrust of the population toward health workers in this type of environment.
Consequently, there is a widening alert in a key part of Africa to avoid more damage to these societies. The World Health Organization alerted Guinea, Senegal, Guinea-Bissau, Mali, Ivory Coast, Sierra Leone and Liberia to possible Ebola infection spread as a result of the cases in Guinea and the DRC. These countries are all facing a mix of warfare, terrorism and disease.
Further spread of the disease could cripple the region’s under-funded health systems, which are also battling the coronavirus pandemic. The Ivory Coast, Mali and Sierra Leone launched plans to stop any spread by reinforcing border controls, on top of their COVID-19-related measures. Given the generally porous borders, however, the possibility of disease spread is high. There are no known combined Ebola-COVID-19 cases yet. What the mix means in terms of environment requirements examination.
The good news is that health authorities are quickly responding to the cases in Guinea. Lessons learned are being applied from the 2013-2016 outbreak. Hence the urgency and response speed is hopefully going to make a difference. Moreover, the development of vaccines and treatments for Ebola have greatly improved survival rates and containment efforts over time, so those lessons are now ready to be applied.
It is important to recall that, in previous Ebola outbreaks, several rebel militia members fighting over the northeastern corner of the DRC died of the virus. An outbreak just last year killed more than 500 people. That outbreak mixed with the country’s violent landscape. At the time, international healthcare officials hoped to develop an inoculation ring by using Rwanda, Uganda and South Sudan in terms of spatial containment. It didn’t work 100 percent, but the experience encouraged greater border monitoring. However, the violence across this part of Africa complicates the ability to stop the pathogen’s spread.
Disease spread along logistics lines is highly probable with Ebola. We saw in previous outbreaks such spread along the rivers of the region. The last time, the concern was with the wide array of river traffic carrying people and goods between Mbandaka and Kinshasa in the DRC, as well as to Brazzaville in the Republic of the Congo and Bangui in the Central African Republic (CAR). Right now, Russian advisers are helping the CAR government with the country’s post-election security. Russia has expertise in Ebola treatment methods and may become a larger player in this arena, along with its COVID-19 program.
Overall, the combination of Ebola and COVID-19 is going to be a challenge. The good news is that there are mechanisms in place to contend with Ebola. The question is whether or not the region’s health systems are already overwhelmed by COVID-19. The combination of the two pathogens in urban areas of this key continent is troublesome. International actors such as China, Russia and the US will play important roles by offering expertise, supplies and assistance. Competition will be stiff.