No Magic Bullet for Ebola

The Ebola outbreak, the second largest and second deadliest in history, continues to rage in the Congo, despite a 90% vaccination rate. According to Michael Ryan, MD, Executive Director of WHO’s Health Emergencies Program, all of the 2031 confirmed cases are in those who are unvaccinated. As of June 5th, 1367 of those infected have succumbed to the disease. The WHO reports there are currently 75 health areas in 12 health zones that have active disease. Since the outbreak began in April of 2018, there have been a cumulative total of 179 health zones and 22 health areas affected. 

Now in its second year, the most significant challenges to containing the current outbreak are geographic and logistical. The rural area of Mabalako presents a particularly difficult problem because the population is spread throughout the region, making it hard to locate those with active disease and to vaccinate the healthy population. Additionally, up to 20 percent of infected individuals seek care outside their health zone, making it challenging to track the spread of disease and to identify contacts of those who are sick. 

The security and safety of those working to contain the outbreak is another concern. The affected regions have spent years in conflict and escalating violence, including frequent and violent attacks against response team members. In April, WHO epidemiologist Dr. Richard Valery Mouzoko Kiboung, 42, was shot and killed during an attack at Butembo University Hospital, where he was chairing a meeting with front-line health workers battling the Ebola virus disease. Deadlyclashes between more than 30 armed militia groups fighting for control of the region have driven families from their homes and into neighboring countries, amplifying the odds that the virus will spread. Distrust of state authorities and international agencies and continued skepticism that the Ebola virus exists has led to the dissemination of misinformation and disinformation that greatly hinders cooperation by the locals with containment efforts. The tenuous relationship between health workers and local residents keeps many from seeking medical care, further driving the spread of disease and decreasing the chance to contain it.

The director of the CDC, Robert Redfield, MD, recently reported the outbreak might last another 18-24 months, which worries the global community. The public position of the CDC is the risk to the US population is very low, citing the readiness of our health care system to respond and contain those infected as the basis of this opinion. Either there are those who mean to create a home-grown misinformation or disinformation campaign or the government and large swaths of the media are not reporting the seriousness of the situation. A quick Google search resulted in a conservative media report accompanied by a Tweet by @BrianKolfage, president and founder of We Build the Wall, Inc, that alleges: 

a DHS insider exposed to us Congo migrants have made it to the USA with confirmed cases of #ebola. 3 are in custody in Laredo Tx and 6 in Laredo, Mexico and in Juarez next to our wall.

 This claim has been circulating on social media for several weeks and is often cited as a reason to close the border. However, 0n June 3, 2019, it was reported by Conservative Review that the: 

Customs and Border Protection (CBP) did confirm that contrary to some internet rumors, as of today, there have been no confirmed cases of Ebola at the border.

The same report indicated that:

While Africans have been trickling over our border in recent months, on Friday, Customs and Border Protection (CBP) announced that “the first large group of people from Africa” were apprehended in the Del Rio sector of Texas. In total, 116 individuals were apprehended in this African caravan on Thursday morning, including 35 from Angola, one from Cameroon, and 80 from Congo. 

Citing the CDC recommendation to isolate potential Ebola carriers for 21 days, the reporter inquired whether the Customs and Border Protection has:

a different protocol for dealing with migrants from Congo or other African countries with risk of diseases, such as not releasing the migrants as immediately as Central Americans. A CBP spokesperson replied that “the process is the same, officers and agents review all individuals they come in contact with for signs of illness and notify CDC as needed”.

There are multiple reports that anywhere from 44 to more than 400 migrants from the Congo and Angola are expected to arrive in San Antonio, Texas in the next few days. After reading numerous sources and reviewing published government data, it has been impossible to find verified data that elucidates the true risk to the US population. However, the experts agree on one thing, the emergency response in DRC will need to be organized, adaptable, overwhelming and executed with precision to contain the current outbreak that is quickly spreading to high traffic regions where internation travel occurs. If migrants fleeing epidemic areas are making it to the United States and other countries, protocols should be implemented immediately that include short-term medical detention & isolation to prevent Ebola viral infections in populated areas of the US where it could be very difficult to contain.

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Cynthia R Stuart DO

Dr. Stuart is Board Certified in Family Medicine. Originally from Georgia, she spent most of her youth in Miami, Florida and has been a Texas resident since the early 1990s. She attended UNTHSC-Fort Worth and completed her residency at UTSW/Methodist Hospital System where she was Chief Resident in her senior year. She is an Associate Professor at UTSW and UNTHSC, participating as a preceptor for medical students and residents. She completed a two-year course at SMU Cox School of Business in Advanced Leadership that enables her to advocate for quality health care providers and local public health programs in her community. She is the head of the Credentials Committee, sits on the Medical Executive Committee and the Ethics Committee at Baylor Scott and White Hospital of Carrollton. She has appeared on numerous news and radio programs to educate the public about various health topics. Dr. Stuart has managed her private practice in Carrollton since 2005 and is now a Direct Primary Care Physician. 

  4 comments for “No Magic Bullet for Ebola

  1. June 12, 2019 at 10:27 pm

    Excellent, sobering article.
    All individuals arriving from central Africa can be tested under existing public health laws—with RT-PCR testing, which should be done in conjunction with antibody serology to detect previous possible Ebola exposures. The incubation period can be longer than 21 days. And what about testing for TB, HV, and other diseases too?
    There are two apparently good Ebola vaccines that generate antibodies—in healthy 20-year-olds on a good diet who are participating in a clinical vaccine trial. But who knows how well they might work in a poor malnourished African villager with a high burden of parasitic disease.

    If entrants from an area with a raging Ebola epidemic are not properly screened, this is criminal incompetence. We might have half a dozen hospital beds in the U.S. where Ebola victims can be safely treated.

    We were very lucky in the last Ebola scare.

  2. Sir Lance-a-lot
    June 11, 2019 at 8:44 am

    “… the emergency response in DRC will need to be organized, adaptable, overwhelming and executed with precision…”

    … Just the way they do everything else in Africa.

    At least the vaccine works.

    When it does get here, it’ll be interesting to watch the anti-vaxxers bleed out of their eyeballs.

    • Pat
      June 11, 2019 at 9:04 am

      😂😂😂 I look forward to their courageous stand.

  3. Pat
    June 11, 2019 at 7:56 am

    In the words of my hero Hank Hill, “I’m trying to prevent an outbreak and you’re driving the monkey to the airport!’

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