Ebola outbreak in a war zone

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**Ouze**

EBOOOOLLLLAAAAAA!!!!!!!!!!

The Latest Ebola Outbreak Is Centered in a War Zone

By Megan Specia
Aug. 2, 2018

A cluster of Ebola cases in the Democratic Republic of Congo — just one week after it declared an end to an outbreak on the other side of the country — is especially worrying because the new infections are in a war zone.

Moreover, a new Ebola vaccine that helped defeat the earlier outbreak may not work this time because the culprit strain of Ebola virus may be different, health officials and aid groups said Thursday.

At least 20 people are believed to have died from the latest outbreak since mid-July, and four of six samples taken from survivors tested positive for Ebola, officials said Wednesday.

The virus, which causes fevers and potentially fatal hemorrhaging, can often spread out of control, as it did during a 2015 outbreak in West Africa.

But North Kivu Province, the volatile region in the Democratic Republic of Congo where the new outbreak is centered, creates security complications that health officials did not confront in the outbreak they just defeated in northwest Équateur Province, 1,550 miles away. The World Health Organization is worried about the safety of medical workers in North Kivu and their access to areas controlled by militants.

“This new cluster is occurring in an environment which is very different from where we were operating in the northwest,” said Dr. Peter Salama, the deputy director general of the health agency and the head of its emergency response unit. “This is an active conflict zone. The major barrier will be safely accessing the affected population.”

The new cases are in and around the remote village of Mangina, near the city of Beni and the border with Uganda. The area has been chronically plagued by fighting between government forces and armed rebel groups. Last year, 15 United Nations peacekeepers were killed in an attack on a compound in North Kivu.

The region also hosts more than one million people displaced by conflict throughout the country and shares porous borders with Rwanda and Uganda.

The World Health Organization said it was working with those neighboring nations to ensure that they were prepared to respond to the disease.

But aid groups fear that the fighting and humanitarian crisis in North Kivu will only compound the difficulties of defeating Ebola. People on the move can frustrate the critical need to determine chains of infection.

“People are hungry and at risk of disease, and many have had to flee their homes,” said Jose Barahona, Oxfam’s country director for the Democratic Republic of Congo. “Ebola poses a serious risk to communities already on the edge and threatens our ability to help them.”

The Équateur outbreak, which killed at least 33 people, was contained within a few months and was officially declared over on July 24.

Health officials believe the use of an experimental vaccine on more than 3,300 people was a major factor in containing that outbreak, but it can only protect against one strain of the virus — Zaire Ebola.

Officials are still working to identify the Ebola strain in North Kivu, the 10th Ebola outbreak in the Democratic Republic of Congo since it was first discovered in the country in 1976, when it was known as Zaire.

Michelle Gayer, the director of emergency health for the International Rescue Committee, said the new outbreak’s location made it unlike what she saw in Équateur and West Africa.

“We are in a different context again in the sense that, yes, it’s actually in small rural areas that we know of to date, however it’s in a zone where there has been a lot of insecurity and a lot of armed groups and a large amount of displacement,” Dr. Gayer said.

Simply getting to an affected community, she said, would be challenging.

“It is already hard because of geography,” Dr.. Gayer explained. “And we can only go where we can go if there is this insecurity.”

Lack of basic resources after years of war, including limited health care, puts North Kivu residents further at risk. Ebola can often spread through community gatherings or funerals, or though contamination at health clinics.

The Health Ministry said a team of 12 experts arrived in the affected area on Thursday, with a mobile laboratory and protective equipment to begin a coordinated response.

The ministry also said additional security measures were in place to ensure the protection of health care workers. The World Health Organization also began sending experts to the area.

“Since we are coming out of another Ebola outbreak, we have kept staff and equipment in place,” said Dr. Matshidiso Moeti, the organization’s regional director for Africa. “This allows us to have a head start in response to this cluster.”

This has the potential to get really ugly.

**Overread**

This indeed has a very nasty potential when the geography and political situation of the area are considered. It's one thing to go into a high risk zone for infection; its a whole other ballgame when the area is a logistics nightmare coupled to being an active warzone.

If its contained fast it could be snuffed out before it gets out of control; but I'd wager if it breaks out and spreads through the Congo it could be very hard to near impossible to control or limited the impact. .

**Togusa**

With the influx of refugees in the area as well, the situation becomes a public health nightmare for authorities trying to contain the infection.

A couple of notes however. The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Secondly, the fact that this is occurring in an active war-zone means that any spread of the illness will be accelerated ten fold due to the the amount of chaos, lack of medical help and the larger number of funerals, which can be the primary vector for the spread of the disease due to the complex nature of African funeral rites.

**Overread**

Togusa wrote:
With the influx of refugees in the area as well, the situation becomes a public health nightmare for authorities trying to contain the infection.

A couple of notes however. The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Secondly, the fact that this is occurring in an active war-zone means that any spread of the illness will be accelerated ten fold due to the the amount of chaos, lack of medical help and the larger number of funerals, which can be the primary vector for the spread of the disease due to the complex nature of African funeral rites.

Not to mention that I suspect the prolonged hostilities in that region might well mean that many people have very poor eduction; that can not only accelerate but also hinder any measures taken to try and curb the spread.
I've also no idea also on how trusting the people will be; either of their own government or of outside influence (keeping in mind that as a warzone there is more than one government/power group present and many peoples might live on contested land and thus might not even have a single ruling body to listen to).

**Ouze**

Togusa wrote:
The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Per the Ministry of health, it's Ebola Zaire - ugly.

**tneva82**

Ouze wrote:
Togusa wrote:
The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Per the Ministry of health, it's Ebola Zaire - ugly.

Well on the flip side:

"Health officials believe the use of an experimental vaccine on more than 3,300 people was a major factor in containing that outbreak, but it can only protect against one strain of the virus — Zaire Ebola. "

Maybe the vaccine, if it can somehow be put in use sufficiently, can help there as well.

**Togusa**

Overread wrote:
Togusa wrote:
With the influx of refugees in the area as well, the situation becomes a public health nightmare for authorities trying to contain the infection.

A couple of notes however. The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Secondly, the fact that this is occurring in an active war-zone means that any spread of the illness will be accelerated ten fold due to the the amount of chaos, lack of medical help and the larger number of funerals, which can be the primary vector for the spread of the disease due to the complex nature of African funeral rites.

Not to mention that I suspect the prolonged hostilities in that region might well mean that many people have very poor eduction; that can not only accelerate but also hinder any measures taken to try and curb the spread.
I've also no idea also on how trusting the people will be; either of their own government or of outside influence (keeping in mind that as a warzone there is more than one government/power group present and many peoples might live on contested land and thus might not even have a single ruling body to listen to).

This is a very good point. During the 2015 west African outbreak, some of the smaller communities began to believe that western doctors had brought the virus to their villages. There were several assaults related to this mass panic and so on.

Automatically Appended Next Post:

Ouze wrote:
Togusa wrote:
The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Per the Ministry of health, it's Ebola Zaire - ugly.

Very, this is the worst of the five strains.

Automatically Appended Next Post:

tneva82 wrote:
Ouze wrote:
Togusa wrote:
The strain of EBOVD matters here, if it is Bundibugyo virus, then the death toll will be much less as the lethality of that strain is much less than that of Zaire or Sudan.

Per the Ministry of health, it's Ebola Zaire - ugly.

Well on the flip side:

"Health officials believe the use of an experimental vaccine on more than 3,300 people was a major factor in containing that outbreak, but it can only protect against one strain of the virus — Zaire Ebola. "

Maybe the vaccine, if it can somehow be put in use sufficiently, can help there as well.

In reality it is still too soon to tell what the effectiveness of the experimental vaccine is. When it was first used three years ago, it was still 5 years away from FDA approval. Even then, the emergency tests in west Africa yielded so much experimental data that I doubt the experts have had even a chance to view a 1/3 of that data since then. But, I hold out hope that it can help. There is still a lot about this disease we just do not understand.

**Dark Apostle 666**

The difficulty of distributing a vaccine, regardless of its effectiveness, could be the major sticking point, if there is conflict in the area - it could be risky for medical staff to operate in those areas.
Also, damage to infrastructure caused by conflict could also cause problems - for instance, by reducing quality of sanitation, leading to further spread of the Virus.

This could get pretty nasty, though I hope it gets nipped in the bud before the virus spreads too much. I imagine the people living in the DRC have enough problems with the civil war without putting Ebola into the mix.

**Ustrello**

Dark Apostle 666 wrote:
The difficulty of distributing a vaccine, regardless of its effectiveness, could be the major sticking point, if there is conflict in the area - it could be risky for medical staff to operate in those areas.
Also, damage to infrastructure caused by conflict could also cause problems - for instance, by reducing quality of sanitation, leading to further spread of the Virus.

This could get pretty nasty, though I hope it gets nipped in the bud before the virus spreads too much. I imagine the people living in the DRC have enough problems with the civil war without putting Ebola into the mix.

I just love the fact that your avatar is a plague doctor

In all seriousness though, Ebola has never made it into a major city before correct?

**Dark Apostle 666**

It is oddly fitting, isn't it?

As far as I can remember, no, I don't think I remember it ever hitting a major city - mostly seemed to be in more rural areas, I think

**Overread**

I suspect that is partly because cities tend to handle the dead differently and might have a more sanitized approach (and might be easier to control and change to a more sanitized approach quicker than rural areas).

Rural areas, esp in Africa, are not calling the morgue nor doctors when someone is fully dead; they are more self sufficient which means when the traditional methods are used several people have a high chance of infection and catching the disease. Which leads to more deaths; more burial preparations and more infection - it basically self perpetuates for a good period of time. Plus there is less coordination, less infrastructure, less trust and often less educational awareness.

**Ouze**

Ustrello wrote:

In all seriousness though, Ebola has never made it into a major city before correct?

Ebola Reston is named after Reston, Virginia, which is where it was discovered. That variant affects primates but it does not affect humans.

There have been a couple of cases of people in the US who have been diagnosed with ebola, usually aid workers who came into contact with someone who is infected elsewhere. If I recall one was in Texas and one was in New York.

I'm not really worried about Ebola in the US or any other country that has a modern medical system. It's pretty hard to catch. The flu is much more dangerous generally. I think it's mostly a problem in African countries because of the way they handle the bodies for funeral rites.

Edit stupid cell phone got me ninja d

**Togusa**

Ustrello wrote:
Dark Apostle 666 wrote:
The difficulty of distributing a vaccine, regardless of its effectiveness, could be the major sticking point, if there is conflict in the area - it could be risky for medical staff to operate in those areas.
Also, damage to infrastructure caused by conflict could also cause problems - for instance, by reducing quality of sanitation, leading to further spread of the Virus.

This could get pretty nasty, though I hope it gets nipped in the bud before the virus spreads too much. I imagine the people living in the DRC have enough problems with the civil war without putting Ebola into the mix.

I just love the fact that your avatar is a plague doctor

In all seriousness though, Ebola has never made it into a major city before correct?

Conakry in Guinea during the 2015 outbreak.
https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/previous-updates.html

The capitol of Guinea is a city of almost 2 million people.

**Grey Templar**

Ebola is basically only a dangerous disease in places without modern sanitation and basic modern medical care. Sure, if you catch it you as an individual are in trouble, but an outbreak in a 1st world country can be easily contained or stymied just by basic sanitation and quarantine practices.

Ebola in terms of potential as a pandemic causing disease is actually pretty low since it only works via direct fluid transmission. It doesn't have any secondary hosts with which it can spread(like fleas or mosquitoes). The closest possible thing like that is eating infected meat from an animal that had the virus, which isn't really an issue anywhere outside Africa.

Diseases to watch out for are ones that can be airborne(via coughing), linger in the environment, or be transmitted by a mobile secondary host like fleas or mosquitoes.

**Togusa**

Grey Templar wrote:
Ebola is basically only a dangerous disease in places without modern sanitation and basic modern medical care. Sure, if you catch it you as an individual are in trouble, but an outbreak in a 1st world country can be easily contained or stymied just by basic sanitation and quarantine practices.

Ebola in terms of potential as a pandemic causing disease is actually pretty low since it only works via direct fluid transmission. It doesn't have any secondary hosts with which it can spread(like fleas or mosquitoes). The closest possible thing like that is eating infected meat from an animal that had the virus, which isn't really an issue anywhere outside Africa.

Diseases to watch out for are ones that can be airborne(via coughing), linger in the environment, or be transmitted by a mobile secondary host like fleas or mosquitoes.

The outbreak and be controlled, but the fact that the mortality rate doesn't change by much is the bigger issue. Sure, only 12 people might catch it before protocols are active. But the likelihood that those 12 people are still going to die a horrendous death is still above 40 to 50%.

Reston for example is of extreme medical significance because it was the first EBOV to exhibit airborne transmission. The saving grace was that it wasn't capable of causing symptoms in humans. If that strain of the virus were to mutate, which is a given because, well, evolution is a bitch like that, then you could see a major issue even in a developed country.

**Dreadwinter**

We should probably shut down the border and detain nurses against their will for no reason. Just to be safe. You never know!

**tneva82**

Togusa wrote:

In reality it is still too soon to tell what the effectiveness of the experimental vaccine is. When it was first used three years ago, it was still 5 years away from FDA approval. Even then, the emergency tests in west Africa yielded so much experimental data that I doubt the experts have had even a chance to view a 1/3 of that data since then. But, I hold out hope that it can help. There is still a lot about this disease we just do not understand.

True. Just hoping for some silver linings on otherwise crappy situation. Maybe it didn't help when it was tried but maybe it did and at least if it had to be that strain at least vaccine, IF it really worked, would work here too.

Small hope but something. Of course getting that vaccine injected in sufficient quantities is whole another issue

**Steve steveson**

Togusa wrote:
Grey Templar wrote:
Ebola is basically only a dangerous disease in places without modern sanitation and basic modern medical care. Sure, if you catch it you as an individual are in trouble, but an outbreak in a 1st world country can be easily contained or stymied just by basic sanitation and quarantine practices.

Ebola in terms of potential as a pandemic causing disease is actually pretty low since it only works via direct fluid transmission. It doesn't have any secondary hosts with which it can spread(like fleas or mosquitoes). The closest possible thing like that is eating infected meat from an animal that had the virus, which isn't really an issue anywhere outside Africa.

Diseases to watch out for are ones that can be airborne(via coughing), linger in the environment, or be transmitted by a mobile secondary host like fleas or mosquitoes.

The outbreak and be controlled, but the fact that the mortality rate doesn't change by much is the bigger issue. Sure, only 12 people might catch it before protocols are active. But the likelihood that those 12 people are still going to die a horrendous death is still above 40 to 50%.

Reston for example is of extreme medical significance because it was the first EBOV to exhibit airborne transmission. The saving grace was that it wasn't capable of causing symptoms in humans. If that strain of the virus were to mutate, which is a given because, well, evolution is a bitch like that, then you could see a major issue even in a developed country.

It may have a high mortality rate, but the point is only those 6 people will die, where are seasonal flu kills thousands of people a year, yet people panic about Ebola and you get media hysteria over a single air worker but with flu people refuse to even have time off work and keep themselves away from others. Suffering from asthma, so being at higher risk of flu complications, this pisses me off.

**Overread**

The biggest killer is your car in modern developed countries. Not only can it kill you but it can leave you with life long crippling injuries too if you're lucky enough to survive! It's a fact that we all know and yet do nothing about and that we actually have encouraged more traffic, more car use and even more commuting.

That said when it comes to the flue it kills, but at the same time the majority of people who catch it don't die, the percentage of deaths for the number of infected is smaller and often its a combination of things not just the flue that kills them.
With ebola the percentage who die from those who catch it goes up dramatically.

When a high percentage of infected die the risk is that continual spread of the disease gives it an increased chance of mutation and adaptation. If it finds a way to mutate into a new strain that can be carried or distributed a new way then you've got huge potential trouble in a highly dense population.

It's this latter risk that gets the health organisations worried because the highly dense and highly mobile society we live in today means that any fast spreading disease as potential to move through countries and over international boarders at alarming speeds. In the long distant past when humans were more tribal such an evolution might wipe out one group, but unless that group contacted another that would be the end of the matter*. So you could have a more localised impact.

At our fastest you could go around the world in 33 hours on Concorde (and that included stopping for fuel). Granted its a little slower now, but we still have huge travel potential which means if one country becomes heavily infected the potential escaping population can spread far and wide. Not to mention those who might migrate out to return to family groups in their native countries.

Even if borders are shut there's still a high potential level of population mobility.

*This is a gross simplification as even ancient humans were very far roaming and conducted not just migrations but significant trade over very large territories.

**BobtheInquisitor**

Dreadwinter wrote:
We should probably shut down the border and detain nurses against their will for no reason. Just to be safe. You never know!

In honor of Dakka's patron saint of Ebola, I suggest we create a Mecial School for child prodigies who will form teams that infect each other with deadly diseases so they can learn to fight those diseases. Child medics must be tempered through adversity.