From Congo’s Mines and Conflict Zones, Ebola Spreads in Silence

(Bloomberg) -- At Nyankunde Hospital in the Ituri province of northeastern Democratic Republic of Congo, Dr. Charles Kashindi is on the frontline of the fight against the latest deadly outbreak of Ebola. Erroneous testing — which targeted a different strain of the viral illness — meant his doctors initially failed to detect their first case of the rare Bundibugyo type this month, prompting what proved to be a misplaced sense of relief. “We said, OK, glory be to God, it’s not Ebola,” Kashindi said by phone. They prepared the victim’s body to hand over to the family, then studied another death with similar symptoms. Less than two weeks later, there are 25 suspected cases at Kashindi’s hospital, which has no isolation rooms, little protective equipment and a rapidly dwindling supply of masks. Multiple staff members are sick, including an American surgeon who was evacuated to Germany for treatment, where he is in stable condition. Four people have died. “It’s truly a cry for help, an SOS,” said Kashindi, who’s being monitored as he was in contact with infected patients. “We’re really afraid of a terrible outbreak here at the hospital.” Nyankunde Hospital, a sprawling referral center serving about 200,000 people across northeastern Congo, has long operated under the pressures of conflict. A sign at the entrance warns visitors not to attack health workers or bring guns into the facility — reminders of the insecurity that has shaped life for decades in this part of Ituri province, physician Lindsey Cooper said in a video tour posted online last May. Congo suffered its first known Ebola outbreak half a century ago. It took nearly 20 years until the next serious one and more than a decade after that until the third. Now, deadly flare-ups like the current one in Ituri occur much more regularly. It’s the 17th outbreak recorded since the first in 1976. And they’re going to keep happening, according to Jean-Jacques Muyembe, the head of Congo’s Institute of Biomedical Research and one of the world’s leading experts on the disease. Some of the uptick in cases can probably be explained by better detection methods, Muyembe told reporters Tuesday. But population growth and climate change, leading to more contact with wildlife, are the main causes of the spread of animal-born diseases like Ebola, he said. It’s a new reality that Congo — and the world — needs to come to terms with, and quickly. The World Health Organization has declared the situation a public health emergency of international concern, its second-highest level of alarm behind a pandemic emergency. The agency said the Bundibugyo outbreak met the threshold because it has no approved vaccine or treatment and is spreading in a conflict-ravaged region with poor infrastructure and high population mobility. By May 20, Congo had recorded 671 suspected cases and 160 suspected deaths across Ituri and North Kivu provinces, including 64 laboratory-confirmed infections. Despite an Ebola surge in the region that ended just six years ago, authorities were slow to recognize the signs this time in part because of the delay in identifying the Bundibugyo strain, according to Muyembe. He acknowledges that the monitoring system failed, which means officials are playing catch-up to stop the spread in a population that already has doubts about trusting the government. Efforts to deal with a viral outbreak are also complicated by the complexities of life on the ground in northeastern Congo. It’s one of the world’s most bio-diverse regions, a site of rich pockets of minerals, and home to multiple armed groups who’ve perpetrated some of the world’s worst violence of the past 30 years. Half the suspected deaths and nearly half the cases thus far have come from Mongbwalu, about 111 kilometers (69 miles) by road from Nyankunde. It’s a remote area full of gold traders and miners who dig with rudimentary tools or basic machinery on permits formerly owned by AngloGold Ashanti Plc. There are few health centers in the area, and sick miners have made the arduous journey to seek treatment at Kashindi’s hospital, according to the doctor. One died two hours after arrival. The word they’ve been repeating about Mongbwalu is “coffins,” Kashindi said, adding that sick diggers were saying that “people were dying, dying, dying” around the mines. According to Muyembe, Congo’s old gold mines are a particular menace because they’re full of bats that can transmit Ebola to animals or humans. “They get the virus, but they don’t get sick, but they still have the virus in their blood,” he said. “And there are bats that are as big as a chicken.” The source of the most recent outbreak hasn’t yet been identified, but in previous incidences of hemorrhagic fevers like Ebola and its cousin, Marburg, meat from wild animals is a primary culprit, Muyembe said. “Bush meat is a principal source of protein for Congolese, at least those who live in rural areas,” he added. “There’s no chicken there, there’s no beef, so one ma