This story originally appeared in The Uptake, a weekly newsletter offering expert insights from the Bloomberg School of Public Health.
On the heels of hantavirus, a rapidly escalating Ebola outbreak in remote areas of the Democratic Republic of the Congo and Uganda has again placed global health systems on alert. As of May 25, more than 230 people have died and there are more than 900 suspected cases reported. The WHO has declared the outbreak a Public Health Emergency of International Concern and warned that the spread of the epidemic is outpacing response efforts.
The outbreak, caused by the very rare Bundibugyo strain, is believed to have originated in the conflict-ridden Ituri Province in northeastern Democratic Republic of the Congo, where population displacement, weak healthcare infrastructure, and limited response capacity are major challenges. The outbreak has spread across a porous border with Uganda.
The outbreak's wide scope suggests that it went undetected for weeks.
"It's going to be all the more challenging [to contain], because it's had so much time to spread," Amesh Adalja, assistant professor at the Bloomberg School of Public Health, told ABC News. "We don't really know exactly what's going on, on the ground. We don't know all the chains of transmission."
A deadly strain with no cure or vaccine
Like most strains of Ebola (except the Zaire strain that triggered the 2013 outbreak), the rare Bundibugyo strain currently has no approved vaccines or targeted therapeutics and carries a 30%–50% fatality rate—significantly complicating response efforts and raising concern about broader regional spread.
There do exist "tried and true principles of Ebola management" such as supportive care, including IV fluids and electrolyte replacement, Adalja told Good Morning America, which "can go a long way to decreasing the mortality," even without strain-specific treatments. Experimental vaccine candidates and monoclonal antibody therapies are under evaluation, though deployment is expected to take time.
The challenges of travel restrictions
Counter to the WHO's recommendations to avoid travel restrictions outside the affected region, on May 18, the CDC announced entry restrictions on non-U.S. passport holders who have been in Uganda, the DRC, or South Sudan in the previous 21 days—a move that was met with concern from the Africa CDC.
"Travel bans make it very hard to actually get things into the outbreak zone," Adalja noted, adding that it's more important to prioritize targeted screening and rapid deployment of resources.
A global response has been activated
The WHO has deployed technical teams and emergency funding, while Africa Centres for Disease Control and Prevention and partner organizations are coordinating regional surveillance, contact tracing, and laboratory support. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health, told Newsweek that authorities in the DRC and Uganda have "decades of experience in Ebola outbreaks," and that personnel from both the African CDC and U.S. Centers for Disease Control and Prevention are actively engaged in response operations on the ground.
The risk to Americans right now is low, Spiegel told Newsweek, as Ebola is not airborne and Bundibugyo spreads only through contact with the bodily fluids of people who are already symptomatic.
If an infected American traveler or healthcare worker does come home with the virus, the U.S. has about 13 Ebola treatment centers that "can handle the highest level of biocontainment," Adalja told ABC News. "We are prepared for this. We learned these lessons back in the 2013–2014 Ebola outbreak in West Africa."
Nonetheless, sweeping cuts to public health infrastructure in the U.S. have made us "worse off now to handle infectious disease threats than at the start of COVID-19," immunologist Gigi Gronvall, a professor in the Department of Environmental Health and Engineering, told The Guardian. "Even a couple of cases [of Ebola] in the U.S. would be challenging with our current workforce," she said.
