Congo's dilemma: From Ebola to Covid-19 and back

Back in March, when Masika became the last Ebola patient to be discharged from hospital in the Democratic Republic of Congo, there was a collective sight of relief in Congo and across the globe. "Thank goodness!" many Congolese and WHO officials exulted — and rightly so.

From August 2018, when the Ebola outbreak was declared, to February 2020, the World Health Organization says around 2,264 Congolese have died from Ebola. That is over 65 percent of the 3,456 people who have so far been infected — the world's second-largest and deadliest Ebola outbreak on record, behind the 2014 West Africa Ebola Epidemic.

Behind each number is a person and a family that will never be the same again.

Today, after two full incubation periods – that's 42 days after Masika was discharged – that collective sigh of relief has turned sour. It is even worrying.

Just as WHO's director-general, Dr Tedros Adhanom Ghebreyesus, who had declared Ebola in Congo "a public health emergency of international concern" in 2019, was preparing to declare Congo Ebola-free officially, a flare-up of new Ebola cases have emerged; ending hopes that this outbreak might be over as locals brace themselves for coronavirus.

The question many people inside and outside of Congo are asking is, what does this mean? The short answer is it means all chains of transmissions have not yet been stopped - and this is quite troubling. Not least because, as tragic, deadly and difficult Ebola is, containing and defeating it is a fight Congo should know how to win by now.

We have the experience, the expertise, the treatment facilities, the mobile laboratories, local technicians and perhaps above all: the Ebola vaccine.

I think if Congolese authorities cannot contain Ebola, which is much deadlier than Covid-19 but far less contagious, than containing the super contagious Covid-19 could be a nightmare. The respiratory virus has already left a trail of infections, sickness, deaths as well as social, trade and travel disruption in Europe and across the globe and scientists believe it is silently gaining momentum and spreading in Congo.

Unlike many countries, Congo has a long, world-beating experience in defeating outbreaks. Since 1976, the year of Mao Zedong's death in China where Covid-19 originated, Congo has contained and defeated ten bouts of Ebola.

In other words, there should be effective social and health control protocols in place. These include things like the tracking of all potential transmissions, safe burial practices and quarantine of hotspots to name but a few. This has been carried over from over 40 years of dealing with Ebola to contain, detect and break every Ebola transmission chain. This is what makes this recent flare-up troubling.

And crucially, what makes it this worrying to me, is because every single day for the past 40 days since Masika was discharged from hospital, thousands of alerts –– people presenting Ebola symptoms or deaths in Ebola hotspots –– have been investigated.

Yet, this flare-up was not picked up until one of the patients, a 26-year-old man from Beni, a north-eastern town at the heart of the outbreak, died at the hospital. Worse still, the longer this flare-up continues, the higher the chances are that people could die and the more likely this outbreak could spread further and faster.

Congo registered its first Covid-19 case on March 10. A month on, there are now 215 Covid-19 cases, which on the surface appears quite neglectful.

"What are 250 cases in a country of 80 million souls?" is the question many Congolese – online and offline – have asked me; ignoring that some of these 80 million are disproportionately affected by underlying health issues like malaria, tuberculosis and other infectious diseases.

Compounding this issue is the high mobility of the Congolese people due to the high level of poverty, famine, wars, insecurity and lack of basic state support which is straining control measures. Combine this with systemic insecurity which hinders the ability of front-line health workers to their job, and you have a recipe for disaster.

Since the outbreak in August 2018, there have been 420 attacks on health facilities responding to Ebola, leading to 11 deaths and 86 injuries among health care workers and patients. Now add to this the fact that Congo –– with its weak healthcare systems which have allowed Ebola to spread like wildfire –– is now fighting both Ebola and Covid-19.

Already, two Covid-19 cases have been reported in the Ebola outbreak zone of Beni.

While the possibility of a fresh, further or faster Ebola outbreak remains slim –– thanks, primarily, to the use of an experimental vaccine, known as rVSV-ZEBOV –– when you study and contrast Covid-19 data from Congo with those from other countries overwhelmed by it you will quickly realise that our infection trajectory over the first 30 days is disturbingly similar to that of Australia and the United States where cases now stand at over 6,000 and 500,000 respectively.

And this is what keeps me up at night. Without a Covid-19 vaccine, we could face rapid community transmission and consequent sickness, immense suffering and an exponential fatality rate.