Today, Explained - Ebola is back

Episode Date: January 23, 2019

The second-largest Ebola outbreak in history is spreading toward a major city. Vox’s Julia Belluz explains whether you should panic now, later, or maybe never. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Remember that big Ebola outbreak in 2014? The biggest outbreak of the virus ever? Well, Ebola is back, and this time it might be even harder to fight. Julia Baluz has been covering the story for Vox. Since August, the DRC has been battling what's now the world's second largest Ebola outbreak in history. Nearly 700 people have been infected and more than 430 have died. This is a really big outbreak. Where do things stand as of right now? Ebola spread into 12 health districts in the country,

which is the regions by which they break up their health system. And that just means it's really geographically dispersed. But the good news is it hasn't yet hit any major cities. You know, when Ebola starts to spread in a city, the response becomes really complicated and difficult, and it's not there yet. But last week, there was four cases confirmed in a place called Kanya, which is halfway between one hotspot of the outbreak and a major DRC city called Goma, with a million people. The worry that the WHO expressed to me last week is that the outbreak appeared to be heading toward Goma,

this major city. And if that happens, then it becomes a much more serious situation and potentially what's called a global public health emergency, which means it's a really grave situation. And I'm quite concerned that it hasn't risen to a higher level of attention because as we know, these viruses don't pay attention to borders

and they move very quickly. It could kill a whole lot more people. So what's being done to prevent the spread of this? Responders finally have an effective Ebola vaccine. It's still an experimental vaccine, but it seems to really work to prevent the spread of this? Responders finally have an effective Ebola vaccine. It's still an experimental vaccine, but it seems to really work to prevent the spread of Ebola. The WHO has said they think the outbreak would already be much larger if they hadn't vaccinated the 60,000 people who have gotten the vaccine so far in DRC. And the other thing that's being done that's a pillar of an Ebola response is something called contact tracing.

What that involves is if you have a case, someone who you think has Ebola or has confirmed Ebola, you go and interview them, all their family members, people they work with, anyone they might have been in contact with, and then you follow them up for 21 days. Wow. And that's the incubation period for Ebola. And if they start to develop symptoms, you quickly isolate them from their family members, the community, and a treatment center to make sure that they don't spread the virus any further. And then the other traditional parts of

an Ebola response, so public health campaigns, the virus spreads through direct contact with bodily fluids. You can easily prevent the spread of the virus by making sure people know not to kiss and hug their neighbors during an Ebola outbreak, to wash their hands, things like that. And so that's happening, and so is safe burial practices. So in this part of the world, it's not unusual to have families care for sick family members until they die. Yeah. Someone who's died of Ebola is filled with the virus,

so that's when they're the most infectious. And these burial ceremonies were identified as super spreader events where all these members of the community would come to visit the dead, kiss and touch the corpse, and then fan out and spread the virus everywhere. And so the health responders are educating people about these burial practices, essentially. Devastated villagers are only given a glimpse of the shrouded body, then a ruthlessly efficient burial. Every piece of contaminated clothing thrown in with the corpse.

And did the health responders from, what, the WHO, from the DRC, did they learn some of these WHO from the DRC, did they learn some of these practices from the last outbreak? This is, I think, been like a pillar of an Ebola response for many, many years, even prior to the last outbreak. You know, we all have customs and ways of doing things. And you have outsiders coming in and telling you, you know, what you're doing isn't right. And these are heavily ingrained cultural, spiritual ceremonies for people. And it's a very difficult thing to change and to interfere with. Cremation remains the safest way to manage the bodies of Ebola victims.

But for villagers, it goes against ancient burial traditions, which involve touching and washing the dead. That is why it is proving so difficult to stop the outbreak of Ebola in the rural areas. And so you often have community resistance and that's happened in this outbreak too. Well, it sounds like there's a lot being done to keep this virus contained right now. There's a lot being done, but the political situation in DRC is making it really hard and creating a lot of uncertainty about what might happen next. Late last year, on December 30th, after years of delays, voters finally went to the polls to elect a new president.

Current outgoing president, Joseph Kibile, delayed this election by two years. He was clinging to power, but was forced to call an election by regional leaders. They voted in a Congolese oil executive and lawmaker called Martin Fayalu, according to people who have analyzed the results and leaked documents that have come out. But in January, the country's electoral commission announced the interim results and said the election actually went to Felix Chisikedi, who was aligned with the outgoing president. Fayulu has contested this election, saying the result is electoral fraud, he will take it to the constitutional court.

And there have been whispers that behind the scene, Kabila was involved in a power-sharing negotiation deal with Chisikedi, and that's why he said nothing. The people voted in one person, and the country's electoral commission is saying no, it went to someone else. Even running up to the election there were already riots and protests. One group of protesters stormed a Doctors Without Borders treatment facility and it had to be shut down and that interrupted part of the response. The police have also fired tear gas at crowds protesting against the decision

to further delay the presidential elections in three cities which are opposition strongholds. There's a very high likelihood that there'll be more protests, more riots, more instability and that that certainly isn't going to make contact tracing and vaccinating and doing all these things that are so important to stopping the spread of the virus. It won't make that any easier. So you've got political turmoil, an undecided election, and this potential brooding for this virus to have this massive outbreak. Yeah, and there's this other thing that makes the outbreak even worse, which is that North Kivu is an active war zone.

North Kivu is the place where most of the cases have been detected. It's the country's most populous province. There are rebels and militia groups that sporadically break out in violence. More than a million people have been displaced. There are also no-go or red zones in the area where health responders can't even reach. So in addition to the current political crisis, there is this ongoing conflict that makes it a very dangerous and unstable place to be for the people there

and also for the outside health workers and aid workers who are coming in and trying to help with the Ebola response. Insecurity will scare away the doctors helping to fight against Ebola. If they leave, then the virus will spread and it will kill even more people. It's a real danger. What happens next, Julia? Is this going to get worse? Will it be contained? Yeah, I don't think we're going to see the situation we saw in West Africa in 2014-16 when Ebola spread in Liberia, Sierra Leone, and Guinea, and we saw almost 30,000 cases. I don't think we're going to see that again.

West Africa was totally caught off guard. They had never dealt with Ebola, the three countries that were most affected. But DRC does have more experience and awareness with Ebola. But what would change the trajectory of the outbreak is if it took off in a major city like Goma or Kinshasa. Doing contact tracing and these basic public health measures that you need to do to stop Ebola just becomes very difficult, unwieldy. And that's part of the reason we ended up with the situation we had in West Africa. Coming up, separating Ebola fact from Ebola fiction. This is Today Explained.

So what is it, January 23rd, 2019? It's probably enough time for you to have made some New Year's resolutions and failed to live up to those New Year's resolutions. Maybe now you can listen to a podcast about New Year's resolutions. There's one called Works For Me. It's a personal journey through some attempts at productivity brought to you by Bloomberg. Every week, the hosts Rebecca Greenfield and Francesca Levy test out a world of self-help ideas on their own workplace problems.

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What do we know about it? So we know it was discovered only in 1976 in the DRC, what was then known as Zaire. The virus had started to spread in a hospital there, unbeknownst to the people who worked there, including some nuns from Belgium. And health officials thought it might be malaria or yellow fever, but the nuns and the other people infected were developing really serious symptoms like hemorrhaging. So health officials sent these specimens off to labs outside of Congo to ask for further analysis to figure out what was making people sick. The researchers discovered that they were dealing with something entirely different,

and they named the virus for a river in the Congo. And, I mean, I know popular culture would lead us to believe this all has to do with, like, monkeys or something, but do we have any idea how this virus infects humans? Yeah, so we know it's a zoonotic virus, which means it has an animal reservoir, so an animal that can live with the virus, and that it sometimes makes the leap into humans, so it spreads from that animal into people. And researchers aren't entirely sure what the animal reservoir for Ebola is, but they think it's the fruit bat.

People in these areas eat fruit bats, and so outbreaks can start when people eat a fruit bat. And once it makes the leap into humans, there are all these different ways that people can spread it around. And what do we know that it does to people now? So for most people, Ebola strikes like the worst and most humiliating flu you can imagine. So you have body aches and sweats. People start vomiting and having uncontrollable diarrhea. They experience dehydration. And when people die of Ebola, they typically die of multi-system organ

failure, which means basically their organs start to be overtaken by the virus and shut down one by one, essentially. The death rate is pretty variable depending on the outbreak, but it's typically, I think, between 50 and 70 percent. How exactly has it traveled since it was discovered, I guess, in the 70s? I know you said it was basically in the DRC, formerly Zaire, and right now we have an outbreak in the DRC, but has it moved across the region, the country, a lot since then? So before 2014, Ebola was typically showing up in Central African countries and in quite rural and remote areas.

And the thinking was that it didn't spread very far. Like people became so sick and so overwhelmed by the virus that they didn't move very far. The virus and outbreaks, because they were in these rural remote areas, were contained pretty quickly. But what happened in 2014 was it ended up showing up in this porous border region at the three countries that were most affected in a small boy, and it wasn't detected for many months. And then because you were, you know, Africa, like the rest of the world is urbanizing. People are moving out of these rural and remote areas into cities and very large cities. And when Ebola was introduced in this new context, that's when it spread like wildfire. And so I think those would be,

so Central African countries and then the West African countries would be the places where we've seen the most burden of illness from the disease. And then in 2014, with the major outbreak, we saw hysteria travel internationally, right? Today, I want to take a few minutes to speak with you directly and clearly about Ebola, what we're doing about it, and what you need to know. Abundance of caution is a phrase that officials and administrators use very often these days. Out of such abundance of caution, a woman was reportedly locked inside an airplane's bathroom after she vomited on a flight from Dallas.

This is a serious disease, but we can't give in to hysteria or fear. I remember it made it to a bowling alley in Brooklyn that was like two blocks away from my apartment. The gutter lanes in Williamsburg, Brooklyn, is getting a good scrub down. This is where Dr. Craig Spencer spent an evening out on Wednesday, just hours before he presented with symptoms of the Ebola virus.

Did you go to that bowling alley after? Not after, no. So you have Ebola in an urban area where people are traveling in and out. There were cases in Spain. We had cases here in the U.S. So you could be sitting next to someone on a plane who has the virus and not know it because they're not showing symptoms yet and contract the virus and spread it around more. But I have to say that is unlikely unless you're going to make out with the person on the plane

or share food with them. And in 2014, when Ebola made it outside of Africa and was hitting Western Europe and the United States, there was this outsized reaction. There was hysteria. There was so much attention from the media. Was it warranted? Yes and no. So yes, because it was the first time we had seen Ebola cases outside of the context of these isolated areas in Central Africa. So people weren't used to having someone with Ebola at their bowling alley in Brooklyn, for example. And it's a serious disease and that's scary. On the other hand, as we learned in 2014, it's not as deadly in a context like the U.S.

So things like kidney dialysis, antibiotics, IV rehydration, they help support people to survive the virus. And with our public health infrastructure here, there's a very low likelihood we'd ever see anything like what we saw in West Africa or what's happening in DRC now. So what is it about this disease then that really captures imaginations as opposed to, say, malaria, which kills many thousands of more people a year, right? It had a Hollywood movie.

Are you talking about Outbreak? I've seen it multiple times. Yes, exactly. Okay, there we go. In a remote African jungle, a small monkey is captured. The monkeys. The monkeys. Dustin Hoffman, Cuba Gooding Jr. The animal carries a deadly virus. There will be panic the likes of which we have never seen.

It's this like cinematic portrayal of the virus that wasn't actually accurate. The New Yorker writer Richard Preston also had this best-selling book on which the movie was based. In the book and in the movie, the virus was represented as causing this hemorrhagic bleeding out of every orifice, out of your eyeballs, everywhere you can imagine. And now we know that that's actually happening only in very rare cases. And during the last outbreak, I actually talked to Richard Preston, who wrote the book, and he said he would love to be able to correct that in the book because it is inaccurate. But it did show this incredibly scary situation. And I think maybe there were seeds of that in people's imaginations. And, you know, malaria, as far as I know, hasn't had this Hollywood portrayal, even though it kills many, many more people than Ebola does in Africa.

But this is still something to be concerned about, right? When it crops up, I mean, it maybe doesn't have to be hysteria and paranoia, but it should be some serious concern. So it's a fine line to walk, but I think we have to put aside the international hysteria we saw last time and these other diseases we know cause a much greater burden of illness in Africa. This outbreak is still a huge deal. It's already scary and devastating to people in DRC, and it's not under control. And if it's left unchecked and and devastating to people in DRC and it's not under control.

And if it's left unchecked and it continues to spread in DRC, the chances that it moves beyond DRC's borders to neighboring countries grow. And that's going to be devastating to the countries involved, to their travel, trade, to their economies, their health systems, their vaccination efforts. And when that happens, Ebola can very easily spiral into a global health emergency again. Julia Belouz reports on health for Vox. I'm Sean Ramos-Firum. This is Today Explained. Unrelated but kind of related, the entire Today Explained team has flu shots. They are Irene Noguchi, Afim Shapiro, Bridget McCarthy, Luke Vander Ploeg, and Noam Hassenfeld.

Plus Sienna Petros. She's our intern. The mysterious Breakmaster Cylinder makes music for the show. And Today Explained is produced in association with Stitcher. We're part of the Vox Media Podcast Network. Thank you.