VASINGTON – Global public health experts are growing more and more alarming about the outbreak of ebola in the northeastern region of the Democratic Republic of the Congo, which has killed 219 people so far. Now is the biggest epidemic ever seen by DRC – with 341 probable and confirmed cases – and the third largest Ebola epidemic in history. And it continues to expand.
While the risk of global expansion remains low, the threat to the country and its neighboring countries is very high. The persistent incidents of insurgent violence in the region affected by the war, protests against the community and the community's resilience to medical intervention have hampered the capacity of the World Health Organization, the DRC Ministry of Health and various non-governmental organizations to respond.
In response to the incident on August 24, the United States pulled out members of the return team from the epicenter to North Kivu to the main Kinshasa cathedral in hundreds of kilometers. US response efforts are now concentrated in Kinshasa and neighboring countries, and US officials announced on Wednesday that the situation is too dangerous to return to North Kivu.
Retention efforts in this epidemic are also hampered, as most of the latest cases do not occur among the familiar contacts of other patients with Ebola, said Dr Peter Salama, WHO Emergency Response Head.
In fact, in the last 30 days, two thirds of reported cases of infectious diseases come from unknown contacts, says Pierre Rollin, a top Ebola expert in US Centers for Disease Control and Prevention. That is 85 cases from 129.
Last Sunday, dr. Robert Redfield, director of the CDC, warned of the possibility of an "endemic" version of Ebola – where the virus is not extinguished, but continues to extend indefinitely across North Kivu populations. Public health officials argued that everything must be done to prevent the horrors of the continuous transmission of Ebola – a situation that has never been seen before.
This [Ebola outbreak] Quickly gets out of control. … on the brink of crisis.
J. Stephen Morrison, Director of the Center for Health Policy CSIS
However, at best, Salama said that the epidemic could have stopped within six months at the earliest. This is a significantly different assessment than that done by the CDC.
"Where we are absolutely in agreement, this is probably the absolutely most difficult context we have ever faced to stop the ebola outbreak," Salama told HuffPost. Global health leaders had to re-evaluate many common control strategies to combat hemorrhagic fever, he said, as they now deal with the massive displaced population in the war zone – a situation Salama repeatedly described as "the perfect storm."
Ron Klein, an Ebola car under then-President Barack Obama, disagrees with that last characterization of "perfect storms". While Ebola has never fought in the war zone before, he argues that this is a "new normal" rather than a one-off situation, at the time of increasing the highest risk of epidemics.
"We will increasingly see these epidemics of disease in problem areas with a history of conflict, with refugees in the vicinity, with difficult political situations, as this is more and more worldwide," said Klain.
"We can not just treat this as some sort of perfect storm of horrible facts that we just have to solve once, never again," he said.
Salama admits that 80 percent of serious disease epidemics occur in sensitive environments. And his more optimistic attempt to control the Ebola epidemic comes with this warning: "as long as security is maintained."
War Zone Nightmare
As the epidemic began in Northern Kivu in late July, attacks by rebel groups and community demonstrations hampered the public health response, which has repeatedly led to the reaction of prisoners to the reaction and halting efforts to vaccinate and monitor contacts.
There were at least 20 major security incidents of various types since the onset of the epidemic, including last weekend, Salama said on Wednesday in the Washington-based Center for Strategic and International Studies (CSIS). All these incidents "have brought us back," he said.
Jeremi Konindik, a senior political associate of the Washington-based Global Development Center, who previously led parts of the Ebola Reaction to Obama administration for 2014, stressed that, no matter how effective the current response is, any attack on insurgents avoids retention efforts .
"Every time we see one of these attacks, the monitoring of the case is severely interrupted and falling, people are fleeing, and you see a corresponding increase in cases next week," Konyndik said. "This means that no matter how much progress we think has been done, it is only lasting, as the security situation allows it."
Read more about the security situation in North Kivu here: "Experts say the Ebola epidemic in the war zone was a nightmare, it was even worse."
Violence has led to a wave of new cases that began in late September. The US government and WHO officials say there has been increased coordination with the United Nations Organization's Stabilization Mission in the Democratic Republic of the Congo, and the peacekeepers have been deployed for years in the area. MONUSCO (acronym based on its name in French) is UN's largest peace mission, but many still worry that violence in the region will continue.
The dangers of further attacks and protests at the forefront of what was already expected to be controversial presidential, regional and legislative elections in the DRC on December 23 are troubling global health leaders.
J. Stephen Morrison, director of CSIS's Center for Health Policy, who led the panel discussion at a think tank event, told HuffPost to "joke on our own" if people think the situation will soon be corrected.
"This [Ebola outbreak] Quickly gets out of control. Just look at the pattern of ADF hits and our inability to stop it, "he said, referring to one of the two rebel groups responsible for the vast majority of the violence." We are on the verge of a crisis. "
The ultimate fear – what Salam called "game changers" – would be an offensive attack on outside workers with the WHO or non-governmental organizations who came to help. There have already been more attacks on local reagals, including volunteers with the Red Cross and two unarmed members of the Emergency Response Unit in the DRC killed.
Given that the Northern Kivu region is currently designated as a threat to UN level 4 security, some sort of direct attack on external medical users would trigger a mark at level 5 and result in the evacuation of these forces – which would be catastrophic for efforts to avoid epidemic.
It's a scary scenario, said Tim Ziemer, deputy governing board member, who is currently working as an assistant assistant to the US Agency for International Development in the Bureau for Democracy, Conflict and Humanitarian Aid.
"We should probably have a lateral meeting at a very high level in order to face the implications and what it requires of us," he said. "We can not be blind and turn our back on this current challenge, because turning the back does not mean it will go," he added.
Ziemer previously served as head of global health safety at the National Security Council, who coordinates the United States response to the outbreak of the DRC. Observers argued that the decision of the national security adviser John Bolton to reorganize this agency earlier this year reduced the power of global health security experts at the White House of Trump.
Country of the US leadership
While global health experts continue to praise the United States for the financial and logistical response to the epidemic – and attributed it to the experimental but already priceless Merck v. Ebola vaccine, which has received more than 30,000 people only in this epidemic – some are wondering if there is a new status home in global health leadership.
"They are from the bottom," said Klein, pointing out that the United States was giving away to other stakeholders on security and the situation on the ground in North Kivu.
"It's not the same kind of leadership from the United States in the global health crisis we've seen before in democratic and republican administrations," Klein added, citing Obama's ebola response and efforts by George V. Bush to Fight HIV / AIDS in Africa. "For an administration that likes to talk about the" First America, "their approach to Ebola was" America is one of many. ""
We can not be blind and turn our back on this current challenge, because turning the back on it does not mean that it will disappear.
Tim Ziemer, senior USAID official
The fact that US response teams are not in the epicenter of outbreaks now depict the "Benghazi hangover", Konyndik argues, suggesting that no one in the current administration focused on the epidemic has enough influence on Bolton's lobbying less President Donald Trump's on this critical issue.
"There is no substitute for existence," Konyndik said.
The lack of a comprehensive global leadership in addition to the WHO also applies to it. "At some point, the response becomes more complicated than what the WHO can manage on its own," Konyndik said.
Indeed, during the 2014 West African epidemic, the WHO was used to pull the foot off. US concerns and resources were ultimately key to the growth of the global response. However, this epidemic killed 11,300 and infected 28,600 more.
Morrison hopes that world leaders do not fight for the time they did from February to August 2014, before they took some measures.
On Ebola Epicenter
In the epicenter of the outbreak, the city of Beni, the spread of Ebola was caused by transmission of the disease in "traditional-modern" objects, according to Salam. Practices in these 300 or more healthcare institutions that combine traditional treatment with modern medicine are not optimal. The workers use the needles again and there are no records they treat.
The simultaneous malaria epidemic drives many – especially children – to the homes of health. The WHO theory is that they come in contact with infectious Ebola patients or have injections with the same needles that are used in patients with Ebola. Without evidence, searching for contacts among the population of those who are exposed through the traditional-modern system is extremely difficult.
This is a critical insight into the spread of the disease, but the WHO first proposed it almost a month ago for STAT. Given all the other challenges of fighting Ebola in an unstable urban community of 200,000 people, it is not clear that this theory is enough to speed up the outbreak soon.
Klein said that sounds like something that has been observed in the WHO public statements over the past several weeks: "the beginning of the exemption." This is a disgrace, he said, given that the organization has made great efforts since its deadly dispute in 2014 and that it should have recently "boasted" for its clarity about the severity of the state of the DRC.
The essence is that this Ebola epidemic is still expanding, not in contracting, in new areas – a total of 14 health zones of significant geographical size, according to a report by the Ministry of Health on Wednesday, and the infection of new, unidentified people.
"Right now, the position of global public health authorities should be to have an epidemic spreading in every way possible, how it can spread, and we do not have relief," said Klein. "And until you try, just do not."