Challenges in Containing the Ebola Virus

You're listening to Shortwave from NPR . Hey Shortwave, it's Regina Barber here. And today I'm joined by NPR global health reporter Jonathan Lambert. Hey John. Hey, Gina. So you're here today to talk about the ongoing Ebola outbreak. Yeah, it's been just about the only thing I've covered over the past month and a half or so. The outbreak has gotten really big, really fast. It's already the third largest Ebola outbreak on record. That's terribles. So where did the numbers stand right now? As of now, there are over a thousand confirmed cases and over two hundred fifty confirmed deaths, but the toll is likely much higher. Why is that? Well, many cases and deaths are probably going uncounted. The outbreak is centered in a region of the Democratic Republic of Congo that's really remote and battered by a lot of ongoing conflict. I see how that could make responding to the outbreak a lot harder. Yeah. And the virus got a head start. It was likely circulating for months before officials realized that it was . That's made it harder to rein in, which is really worrisome for a disease that on average kills about half the people it infects. So do scientists have a sense of how bad it could get ? Well, the CDC projects that in the absence of robust control measures, as many as twenty thousand could be sick by August . If it continues at that pace, it could rival the twenty fourteen to twenty sixteen Ebola outbreak in West Africa, which killed over eleven thousand people. And there are concerns that it could spread more widely in the region . So today on the show , how this became one of the largest Ebola outbreaks in history. And what has to happen to treat patients and get it under control? You're listening to Shirwave, the science podcast from NPR . Okay, so John, remind us of some of the basics of Ebola. Yeah, it's a disease caused by a virus specifically theth Oor Ebola virus. The first known outbreak was in nineteen seventy six in the Democratic Republic of Congo. Since then, at least a couple dozen outbreaks have occurred, mostly from East to West Africa. So what causes an outbreak to occur? Usually it's a spillover event. That's when a virus that typically circulates in non human animals jumps from an animal to a human. Scientists aren't sure how many animals harbor Ebola, but they do know that it circulates in some b ats. So how does this virus get from the bat to the human? It's not exactly clear. In many parts of East and West Africa, some people eat bat meat for food and could get exposed that way. Exposure to guano or bat poop could be another route. Yeah, this reminds me of COVID , but this infection is much more serious, right? Right, Ebola is a very deadly disease, and its deadliness stems in part from a kind of sneakiness . Like how is it sneaky? So when the virus first infects a person, it goes straight for key immune cells. Typically, these cells help spur the production of antibodies which allow the immune system to target a pathogen. But by attacking these cells first, Ebola viruses delay this response . And that gives the virus a huge head start. This is terrifying. Yeah. So the virus first goes to the lymph nodes, then to the spleen, the liver and kidneys, replicating and damaging these tissues as it goes. I spoke to virlogist John Conner at Boston University about this. Here's how he put it. The cleaning and garbage disposal units of the body are backing up and that backs up into the blood system that has a lot of negative consequences. And these cascading problems can be very damaging. And that's often that's why you get to death. One major cause of death is just loss of all these fluids through vomiting and diarrhea. Patients can lose up to ten liters a day. That is so much. That's like over two and a half gallons. Yeah, and it's through contact with those bodily fluids or handling infected dead bodies that the virus spreads . So we compared it to COVID earlier, it's not spread through droplets in the air like that. So Ebola isn't as contagious. Yeah, but it's still sounds like an awful disease. It is. And that's why health officials are really usually on the lookout for it. And over the last decade or so, countries like DRC that experience a lot of Ebola outbreaks have really beefed up their surveillance systems. For instance, they've built up lab infrastructure so they can test samples that might be from Ebola patients. U. S. foreign aid really helped build up those systems, and in recent years, it's helped outbreaks get declared relatively early on. Okay, so usually they're caught pretty early, but you're saying that didn't happen for this current situation. No, so when the outbreak was declared on may fifteenth, that initial death toll had already reached sixty five. I track outbreaks like these pretty closely and when I saw that announcement, I had this like moment of panic that I'd somehow missed earlier reports because the numbers just seemed too big for a new outbreak. Oh wow. Now health officials suspect the outbreak wasn't new then, and it likely started months ago, perhaps as early as February. So why was there a delay in declaring it? A few reasons. Like I said, it's a tough region to work in because it's remote and there's conflict , and the species of Ebola that's spreading is a rarer one. It's called Bundabougio, and there have been only two other outbreaks of it in two thousand seven and twenty twelve. Genetically, it's like thirty percent different than the more common species . Unfortunately, that means that the tests that DRC typically uses can't detect it, so cases that seemed like Ebola kept turning up negative. Ooh, so how did they eventually tell it was Ebola? Health officials shipped samples to a bigger lab in Kinshasa, DRC's capital, where they did more sophisticated tests , but even that process was delayed. Early samples weren't shipped properly, and there were delays in those shipments.. Wow Yeah. And these outbreak surveillance activities are the kind of thing that used to be heavily supported by US foreign aid, including by USAID. And after the Trump administration's massive aid cuts last year, I'm sure it was affected . Yeah, a lot of it is gone. The State Department has said that it's false to claim that those cuts impacted the Ebola response, but I've spoken with a lot of global health experts who think it contributed. One of them was Anna Bod ipob Umayamba. She worked on the Ebola response in DRC for USAID. When you dismantle those programs, you no longer have your frontline eyes nears on the ground that can alert you. And so it's very easy for an outbreak to spread very quickly. And the outbreak is clearly spreading quickly now. So how are health officials responding? On a few fronts, they've significantly ramped up testing. So now there are more labs that can test samples in the Northeast where this outbreak is , and they added testing machines that can detect Bundabujo, this rarer species of Ebola. So that's good. But WHO officials told me that they need to do a lot more testing to keep up. And as they do that testing, once somebody's results comes up positive, what happens? Well, from a public health perspective, the hope is that they isolate to limit further spread . Now you can't make an infected person do that, but you can hope that they do. Meanwhile, health officials work to figure out their contacts and hopefully get them to quarantine in case they're infected too. There isn't an approved vacc ine for this species of Ebola, so this kind of basic bread and butter response is the main tool that officials have to curb the spread. What about treating the disease? Like are there any approved treatments for Ebola? Unfortunately not for this, kind of Ebola. Now that doesn't mean patients can't be treated at all. Providing what's called basic supportive care, like replacing lost fluids, treating pain, treating other coinfections can help people recover. And at least one hundred people already have. That's good. Yeah, but this kind of care isn't available everywhere . And health officials are scrambling to set up treatment centers in more remote areas, but those are still out of reach for many. And the conditions in some of those centers are really rough for both providers and patients. I'm here in Guampara Ebola Treatment Center. This is journalist Emmett Livingstone, who is reporting on Ebola for NPR in the DRC. He visited a clinic earlier this month. All of us are in full protective gear which includes a bib , two layers of clothing, several layers of gloves , goggles, a mask . It's difficult to describe the level of discomfort wearing one of these suits. It's very hot in a turi, the sun is bright . It's very difficult to breathe inside the suit and on top of that the goggles fog up, so it's also difficult to see. Working under these conditions makes it hard for doctors to treat patients and it's obviously a difficult situation for those patients. The Ebola patients themselves, some of them appear to be in a great deal of pain. We heard some people crying out . The doctor said that at a certain stage of the Ebola virus disease the whole body aches and it's extremely painful. This all sounds so heartbreaking . Yeah, it is not good . I sp'ovek toen a number of clinicians who've worked in Ebola wards in the past and they've described some really harrowing experiences . But they also maintained that Ebola isn't a death sentence, and with access to high quality care, people can get better. It's just really hard to access that kind of care in the places where Ebola typically spreads. So we're now a month into the official outbreak. What are you watching for now? A few things. One is just how big the outbreak continues to get and where it goes. Right now it's still mostly in DRC with a handful of cases in Uganda, but that could change. I'm also closely watching if contact tracing becomes more robust. Right now, only a little over half of contacts are being identified by officials. Experts are telling me that that's way too low, and that percentage ticking up will be a sign that the outbreak is starting to get under control . So what about new treatments? Like could those come anytime soon? There are efforts underway to quickly stand up clinical trials to test possible treatments in vaccines. Those take time, probably at the ear liest month or two, but the sooner they start, the sooner clinicians and health officials could have more powerful tools to treat patients and rain this outbreak in. John, thank you so much for bringing us this report ing. Of course, Gina . This episode was produced by Hannah Chin and edited by Rebecca Amiras. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer. I'm Jonathan Lambert. And I'm Regina Barber. Thank you for listening to Shorewave, the science podcast from NPR.