Potential spread of Ebola ‘warrants serious concern,’ WHO chief says

By Billy Stockwell, Sana Noor Haq, Jonny Hallam, CNN

(CNN) — The head of the World Health Organization said Tuesday the scale and speed of the deadly Ebola outbreak in the Democratic Republic of Congo (DRC) and Uganda “warrants serious concern,” as healthcare workers struggle to reach hundreds of thousands of people displaced by conflict in hard-to-reach in parts of the region.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus said that more than 130 deaths are thought to be linked to the outbreak, with more than 500 suspected cases.

Tedros declared the outbreak a public health emergency of international concern on Saturday, the first time a WHO chief has done so before convening an emergency committee.

In an address to members of the World Health Assembly in Geneva on Tuesday, Tedros pointed to worrying factors that he said mean the outbreak has the potential to spread further and cause more deaths.

Cases have been reported in urban areas including Kampala, the city of Goma in the DRC and Bunia, “which is a big city,” he said.

There are also signs of healthcare-associated transmission of the virus, after deaths were reported among health workers, he said.

Furthermore, Tedros said that insecurity due to conflict in the remote DRC province of Ituri – where the virus was first detected in early May – has intensified over the past two months, causing significant population movement in the area. “Over 100,000 people have been newly displaced,” Tedros said, warning that the movement of people during an Ebola outbreak could “increase the risk of further spread.”

Finally, Tedros noted that the epidemic is caused by the Bundibugyo strain, “a species of Ebola virus for which there are no vaccines or therapeutics.”

Ebola has an average fatality rate of 50%, according to WHO. The disease is spread through direct contact with the bodily fluids of an infected person, according to the Africa Centres for Disease Control and Prevention (Africa CDC). It can also be passed through contact with contaminated materials or a person who has died from the disease.

Symptoms include fever, fatigue, muscle pain and headaches, to vomiting, diarrhea, abdominal pain and diminished kidney and liver functions, according to WHO. Some patients may have internal and external bleeding, including oozing from the gums and blood in the stool.

There are no approved treatments or vaccines specific to the Bundibugyo virus. Medical workers are trying to develop a monoclonal antibody therapy as a potential treatment, Dr. Satish Pillai, a deputy director in the Division of Preparedness and Emerging Infections at the US CDC Centers for Disease Control and Prevention (CDC), said Monday without stating a timeline.

The initial round of detections were slowed down because local tests in Bunia – where the first patient thought to have caught this strain of Ebola died – showed negative results for the more common Zaire strain, according to WHO’s representative in the DRC, Dr. Anne Ancia.

Genetic fingerprinting from the outbreak “is similar” to those from outbreaks in 2007 and 2012, according to the US CDC, meaning medical workers have the diagnostics equipment to detect this strain of Ebola virus.

War, displacement stifle relief efforts

Regional aid and health officials say years of war, crippling aid cuts and acute malnutrition in parts of the DRC have hindered response efforts as the viral flareup tore through communities in Ituri province.

One relief staffer warned that children are “most vulnerable” in the wake of the outbreak. Philippe Guiton, the national director for the global nonprofit World Vision in the DRC, said they are “already heavily affected by conflict and where humanitarian assistance remains insufficient due to lack of resources.”

The east zone director at World Vision, David Munkley, added that “Ituri is already facing an alarming situation of acute malnutrition, which further weakens people’s immune systems, combined with extremely limited access to healthcare in remote areas.”

In Ituri, 11,000 South Sudan refugees need “preventive assistance,” the UN’s refugee agency reported Tuesday. Elsewhere, in the DRC’s North Kivu province, in the rebel-held city of Goma, more than 2,000 Rwandan and Burundian refugees need sanitary supplies, the agency added.

US Secretary of State Marco Rubio conceded that areas in the DRC where cases had been reported were “a little tough to get to.” “It’s in a rural area, so it’s kind of confined in a hard to get to place in a war-torn country, unfortunately,” he said Tuesday in his first remarks since the outbreak began.

Others voiced concern over why authorities took so long to identify and track initial cases after a string of Ebola outbreaks in the past several years. The largest outbreak occurred in West Africa from 2014 to 2016, when 11,325 people died and more than 28,600 were infected, according to WHO.

“I’ve been saying the most concerning thing to me has been how much we learned, how quickly we learned it,” Dr. Craig Spencer, a doctor who survived an Ebola infection in 2014, told CNN on Monday. “There’s no doubt that this is probably much worse than what we think right now. I suspect the true case total is much higher than what’s being reported.”

In response to the growing epidemic, the US invoked a public health law on Monday to limit entry into the country from the affected region just as one US national tested positive for the strain in the DRC. The American citizen is being transported to Germany for treatment at Berlin’s Charité University Hospital, the German health ministry said Tuesday.

Ugandan authorities sought to reassure visitors on Tuesday, insisting that there has been no local transmission within the country despite the two cases, which the Uganda Tourism Board said involved Congolese nationals “who entered Uganda from the DRC.”

The Africa CDC criticized the US’ travel restrictions, saying “broad travel bans can disrupt lives and economies.”

Later Tuesday, the State Department warned Americans against all travel to the DRC, South Sudan and Uganda, and to reconsider travel to Rwanda due to the outbreak in the region.

When did the epidemic start?

The first suspected case was a health worker whose symptoms started on April 24, according to WHO. The person later died at a medical center in Bunia, the capital of Ituri province.

Then, on May 5, WHO received an alert about an “unknown illness” with high mortality in the province, the agency said. After an investigation by a “rapid response team” on May 13, the outbreak was confirmed as Bundibugyo virus on May 15.

Jeremy Konyndyk, former lead for Covid and disaster relief at the US Agency for International Development (USAID), said multiple “generations of transmission” must have gone undetected before the outbreak was confirmed, which he said was a “big, big problem.”

On Sunday, the UN health body declared the epidemic a “public health emergency of international concern” and said the high positivity rate and increasing number of cases and deaths point toward “a potentially much larger outbreak.”

Ancia, WHO’s representative in the DRC, confirmed Tuesday that the outbreak has also spread to North Kivu province, which directly borders Ituri province, but added that there is still “significant uncertainty” about the true number of infections.

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CNN’s Jennifer Hansler, Lauren Kent, Claudia Otto, Ben Tinker and Niamh Kennedy contributed reporting.