A health worker in an Ebola treatment center, Beni, North Kivu, Congo, May 2019
Article initially published in The New York Review on October 24, 2019 and written by Annie Sparrow.
Since the Ebola outbreak in the Democratic Republic of Congo began in the summer of 2018, there have been more than 3,039 confirmed cases of the disease and more than 2,013 deaths there as of mid-September 2019. It is the worst Ebola outbreak in history after the West African epidemic of 2014–2016, during which there were 28,652 cases and 11,325 deaths. All but a handful of the cases have occurred in eastern Congo, much of which is difficult to reach, with dense forests and poor roads. But this is also the first outbreak in an active conflict zone, and attacks on medical workers have hampered the efforts to contain it, as has distrust among Congolese of the government and of the methods and priorities of international aid agencies. The outbreak’s persistence has brought into sharp relief the shortcomings of the international response to Ebola, and to emerging disease threats more generally.
Ebola, a hemorrhagic fever virus that was discovered in Congo in 1976, has a terrifying reputation for extraordinary contagiousness and lethality: in the public imagination, those infected inevitably end up “bleeding to death from every orifice.” The film Outbreak (1995) reinforced that reputation: it depicted a thinly fictionalized airborne version of Ebola so dangerous that the army decides to bomb the California town to which it has spread, less to prevent continent-wide contagion than to protect its potential as a biological weapon. A virus emerging from Africa and able to cause certain death by vascular meltdown seemed made for Hollywood. Yet until 2014, none of the twenty-odd outbreaks in remote parts of Congo, Uganda, South Sudan, Gabon, and Congo- Brazzaville had lasted longer than a few months or caused more than 280 deaths.
In 2014, as Ebola began to spread swiftly across Liberia and Sierra Leone, the West still seemed invulnerable to it. But that changed on August 2, 2014, when an American doctor infected with the virus was medevacked back to the US from Liberia. Three days later, a second infected aid worker was evacuated. American news stories raised alarms about Ebola “coming to our shores.” The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC). The US Centers for Disease Control predicted that 1.4 million people would be infected in West Africa; its failure to prevent the arrival in the US of the first traveler infected with the disease, a Liberian man diagnosed on September 30 in Dallas, did nothing to reassure the public. Two nurses at the Texas Health Presbyterian Hospital, where he was being treated, then became infected—the first transmission of Ebola outside Africa. Soon Amazon was selling Ebola survival kits complete with Hazmat suits, body bags, bleach, and lots of duct tape. Serious survivalists planned for months of isolation. The US government sent the 101st Airborne Division to Liberia to help fight the outbreak. Thirty governments stopped flights to the region.
In the end, Ebola remained largely confined to West Africa. Only three people were infected outside Africa—two in the United States and one in Spain. Of the twenty-seven cases treated outside Africa, five deaths occurred among those treated in either the US or Europe. Yet the panic suggested how sheltered from epidemic diseases the West had become.
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