At last, the Ebola epidemic that has been continuing in the eastern Democratic Republic of the Congo since 2018 is finally set to be declared over by the World Health Organization (WHO). The announcement, expected on 12 April, follows a difficult two years in which the virus killed 66 per cent of the more than 3400 people who were infected.
But celebrations at the Ebola Treatment Centre in Beni, a city once at the heart of the outbreak, will be muted. Just as one epidemic is coming to an end, another is just getting started: the coronavirus arrived in the surrounding North Kivu province last week.
“The battle is won, but the war is far from over,” says Esther Sokolua Perso, who has led the centre’s medical team since June 2019.
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“We have achieved a great success working together as a machine,” says Perso, who has had to cancel a ceremony marking the end of Ebola due to the coronavirus. “But there is no time to relax and we must be ready and prepared for the worst.”
The end of the Ebola epidemic is a significant achievement. In a country that has experienced decades of civil war, identifying and isolating the contacts of those who contracted Ebola was extremely challenging. But a successful mass monitoring programme has conducted almost 160 million screenings for Ebola symptoms at regional checkpoints since August 2018.
In addition to this monitoring, two experimental vaccines have helped turn the tide. Nearly 320,000 people have been given either a vaccine made by Merck, which proved highly protective during the 2015 Ebola outbreak in Guinea, or a vaccine made by Johnson & Johnson, which began clinical trials in the DRC in late 2019. This vaccine was deployed using a “ring strategy”, specifically targeting the contacts of those diagnosed with the virus.
“It was very effective,” says Bérengère Guais, regional emergency coordinator for Médecins sans Frontières. “But we still don’t have a perfect knowledge of the disease and we are learning all the time.”
A different kind of virus
There is a risk that recovered patients could relapse or that a fresh outbreak could emerge. Like the covid-19 virus, Ebola can pass from animals to humans. But Ebola is different in that it requires direct contact with bodily fluid to spread from person to person, while covid-19 appears to mainly spread through respiratory droplets via coughs and sneezes.
Ebola has a 21-day incubation period and is only infectious once people show symptoms, which are often severe. But the coronavirus can be transmitted even when people are symptomless, meaning it spreads far more easily than Ebola.
The coronavirus, then, is a different challenge, but the Ebola epidemic has at least somewhat prepared the eastern DRC.
Gervais Folefack, the WHO’s incident manager for covid-19 in the DRC, says healthcare workers are being trained in rapid diagnosis, airports have isolation chambers and treatment centres have been built to provide easy access for rural communities. The country has many checkpoints where it is obligatory to check temperatures and wash hands in chlorinated water.
While this is a “big advantage”, the coronavirus presents novel problems, says Folefack. “Now we need ventilators when that wasn’t the case for Ebola,” he says. “And because coronavirus spreads more easily, the challenge is to not overwhelm our limited capacity.”
So far, there have been 183 confirmed cases of coronavirus in the country. Although only two were in Beni, the city began a two-week lockdown on Monday in which no one can enter or exit. However, within Beni, business continues as usual, with many residents unable to afford face masks.
On the city’s streets, there is an acute awareness of the fragile state of the country’s healthcare system and its heavy reliance on international support. This support helped end the Ebola epidemic, but hasn’t yet been as forthcoming amid the global coronavirus crisis.
“We need the funding,” says Justin Mupanda, a motorbike taxi driver. “If it’s caused this much chaos and death around the world already, then us Congolese could be crushed like flies.”
