Top WHO official sees progress in grueling fight against Ebola outbreak

Six months after the ongoing Ebola outbreak in the Democratic Republic of the Congo began, efforts to stop spread of the disease are producing signs of progress, a senior World Health Organization official told STAT on Thursday.

Transmission has either been halted or significantly reduced in a number of the areas where the disease has spread, said Dr. Mike Ryan, assistant director of the WHO’s emergency preparedness and response program.

But there is still intense transmission in a large city, Katwa, and stopping the disease there is not going to be an easy task, said Ryan. He described the outbreak as more of a series of linked epidemics than one large outbreak.

“The real challenge now is containing the disease and suppressing it there before it does what it’s done before and bounced to somewhere else,” said Ryan, who recently returned to WHO headquarters in Geneva from the latest of several stints in the outbreak zone.

“We have the teams. We have the resources. We now have the entry point with the community. We have the political leadership. … All of the ingredients to make progress are there,” he said. “But it’s making progress quickly enough before the disease bounces and goes somewhere else. And that’s my concern.”

The outbreak, which was declared on Aug. 1, is the second largest ever. As of Thursday, 759 cases have been recorded, and 468 of those people have died.

So far, 18 health zones in two provinces in northeastern Congo — North Kivu and Ituri — have reported cases. That part of the country is engulfed in a decades-long conflict that has significantly hampered efforts to stop spread of the virus.

While moving about can be difficult — unsafe — for the outbreak response workers, people in the area, which is populous, are highly mobile. That has allowed for a frustrating phenomenon in which someone who gets infected in one area will travel to another to evade detection or to be with family, igniting transmission in a new location. On more than one occasion, a place where Ebola transmission had been stopped has experienced renewed spread sparked by the arrival of another infected person.

Earlier this week, the Congolese ministry of health reported on the case of a traveling trader who contracted the disease in Katwa and then returned to his home in Watsa, more than 300 miles — and more than nine hours by road — away. Ryan said a response team quickly moved in and vaccinated the man’s contacts and their contacts to try to prevent the virus from taking off once again.

For much of the autumn the major transmission hot spot was a city of more than 200,000 people called Beni. But after months of effort — and the administration of more than 20,000 doses of an experimental Ebola vaccine made by Merck — the outbreak there appears to be on the verge of ending, Ryan said.

The city had gone nearly three weeks without a case, but recently six new infections there have been reported. All were connected to known chains of transmission, said Ryan, who described the outbreak in Beni as being on “that bouncy road to zero.”

Katwa — and the neighboring city of Butembo — have been harder nuts to crack, with members of the community refusing in many cases to cooperate with the response teams. But Ryan said efforts to get community leaders and civil society groups engaged in the containment fight are bearing fruit.

The number of alerts — tips from people that someone might have Ebola — is on the rise. And people sick with the virus are going to treatments centers earlier in their illness. Where a few weeks ago most people waited eight or 10 days to go, many are now showing up two or three days after developing symptoms. That’s critical: Cases cared for in treatment centers are more likely to survive. It also lowers the risk they’ll transmit the virus to family members.

“Even in Katwa, where there is intense transmission, there are hopeful signs,” said Ryan.

Still, as the grueling outbreak enters month seven, response leaders aren’t taking anything for granted. “A tremendous amount has been achieved. But we’re not done. And we’re nowhere close to being done,” Ryan said. “And we’re going to be working in Katwa for weeks to come to suppress transmission.”