From Congolese mines and conflict zones, Ebola spreads silently

(Bloomberg) — At Nyankunde Hospital in Ituri Province in the northeastern Democratic Republic of the Congo, Dr. Charles Kashindi on the front lines of the latest deadly Ebola outbreak.

Flawed testing – which targeted a different strain of the viral disease – meant his doctors failed to detect their first case of the rare type of Bundibugyo earlier this month, prompting what turned out to be a misplaced sense of relief.

“We said, OK, thank God, it’s not Ebola,” Kashindi said on the phone. They prepared the victim’s body to hand over to the family and then studied other deaths with similar symptoms.

Less than two weeks later, there are 25 suspected cases at Kashindi Hospital, which has no isolation rooms, little protective gear and a rapidly dwindling supply of masks. Several employees are ill, including an American surgeon who was evacuated to Germany for treatment, where he is in stable condition. Four people died.

“It’s really a cry for help, an SOS,” said Kashindi, who is being monitored because he was in contact with infected patients. “We are really afraid of a terrible outbreak here at the hospital.

Nyankunde Hospital, a sprawling referral center serving some 200,000 people in northeastern Congo, has long operated under the pressure of conflict. A sign at the entrance warns visitors not to attack health workers and not to bring weapons into the facility — a reminder of the insecurity that has shaped life in this part of Ituri province for decades, doctor Lindsey Cooper said in a video tour posted online last May.

Congo suffered the first known outbreak of Ebola half a century ago. It was nearly 20 years before another serious one occurred, and more than a decade after that for a third.

Now, deadly outbreaks like the current one in Ituri occur much more regularly. It is the 17th outbreak recorded since the first in 1976. And according to Jean-Jacques Muyembe, the head of the National Institute for Biomedical Research in the Congo and one of the world’s leading experts on the disease, there will be more.

Some of the increase in cases can probably be explained by better detection methods, Muyembe told reporters on Tuesday. But population growth and climate change, which leads to more contact with wild animals, are the main causes of the spread of animal-borne diseases such as Ebola, he said.

It is a new reality that the Congo – and the world – must come to terms with quickly.

The World Health Organization has declared the situation a public health emergency of international concern, the second highest level of alert after a pandemic. The agency said the Bundibugyo outbreak has reached a threshold because it has no approved vaccine or treatment and is spreading in a conflict-torn area with poor infrastructure and high population mobility.

As of May 20, Congo has reported 671 suspected cases and 160 suspected deaths in Ituri and North Kivu provinces, including 64 laboratory-confirmed infections. Despite a surge in Ebola in the region that ended just six years ago, authorities were slow to recognize the symptoms this time, partly because of delays in identifying the Bundibugyo tribe, Muyembe says.

He acknowledges that the monitoring system has failed, meaning officials are scrambling to stop the spread among a population that already has doubts about trusting the government.

Efforts to deal with the outbreak are also complicated by the complexity of life on the ground in northeastern Congo. It is one of the most biodiverse regions in the world, a place with rich mineral reserves and home to many armed groups that have committed some of the world’s worst violence in the last 30 years.

Half of the suspected deaths and almost half of the cases so far are from Mongbwal, about 111 kilometers (69 mi) by road from Nyankunda. It is a remote area filled with gold traders and miners who dig with basic tools or basic machinery on a permit formerly owned by AngloGold Ashanti Plc.

There are few health centers in the area and sick miners had to make a difficult journey to seek treatment at the hospital in Kashindi, according to the doctor. One died two hours after arrival.

The word they kept repeating about Mongbwala is “coffin”, Kashindi said, adding that the sick miners said “people were dying, dying, dying” around the mines.

According to Muyembe, old gold mines in the Congo are a particular threat because they are full of bats that can transmit Ebola to animals or people.

“They get the virus, but they don’t get sick, but they still have the virus in their blood,” he said. “And there are bats that are as big as a chicken.

The source of the latest outbreak has not yet been identified, but in previous cases of hemorrhagic fevers such as Ebola and its cousin Marburg, meat from wild animals is the main culprit, Muyembe said.

“Bush meat is the main source of protein for Congolese, at least for those living in rural areas,” he added. “There’s no chicken, there’s no beef, so you get by on the game.”

Jennifer Hinton, a Canadian who has worked on sustainable mining projects from the Congolese border in Uganda for two decades, lived through the Marburg outbreak there. In 2009, she invested in a colonial-era gold mine after Marburg—probably one of the region’s millions of bats—killed its owner.

Hinton remembers the first time she saw bats flying over Uganda’s lakes.

“I was squinting and wondering, is there a storm coming?” she said. “And they’re bats, bats. There’s millions of them. It’s pretty spectacular.”

Scientists estimate that thousands of bats in a single colony could carry Marburg and pass it on to any person or animal that is bitten or eaten uncooked, which presented an unexpected problem at the mining site.

“I just see 25 baboons sitting outside in front of the tunnel, catching bats out of the sky like they’re apples from a tree, just happily munching away,” Hinton told Bloomberg.

She said staff in Uganda knew how to protect themselves from Marburg and were all familiar with contact tracing after several outbreaks of hemorrhagic fevers over the years. Before she got involved, the workers trapped the bats in the mine to kill them while her project scared the rest due to the increased noise, lights and activity.

The situation in the epicenter of Ebola in Mongbwal is more complicated. Much of the population is reluctant to follow the instructions of health officials, believing that Ebola is mystical. “Like a spirit of death,” says Kashindi.

It does not help that the authorities do not have full control over Mongbwalu, which is home to many armed groups linked to local ethnic communities.

In one case in 2020 and 2021, a group known as Codeco sent more than 5,000 fighters to patrol and mine in Mongbwal, according to a 2021 United Nations report. Just last month, Codeco massacred at least 69 people from a rival ethnic community not far from the mines, AFP reported, citing local security forces.

The conflict between the two communities — Hema and Lendu — has been going on for years. At its worst in 2002, Nyankunde Hospital lost power from the grid. The hospital has been using generators and solar power ever since, Kashindi says.

Congolese soldiers and police are also not always to be trusted. According to a 2022 UN report, security forces stationed in Mongbwal “also engaged in illegal gold mining and taxation of diggers”.

Congolese Health Minister Roger Kamba insists his government is capable of handling the latest Ebola outbreak — after all, there have been 16 before and all but one without a vaccine.

“We have the expertise,” Kamba said. “Ebola is not a mystical disease.

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–With assistance from Naomi Kresge, Jeremy Diamond, Janice Kew, and Jason Gale.

(Update to add hospital details in sixth paragraph; updated case numbers in 12th)

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