Year After Latest Ebola Outbreak, New Cases Emerge in Congo

One year ago, the World Health Organization declared an outbreak of the Ebola virus in the Democratic Republic of Congo after the deadly disease was discovered in the country’s North Kivu Province.

In the months since, the virus has continued to spread — two weeks ago, the outbreak was declared a global health emergency — with more than 2,600 people infected and over 1,800 killed, according to W.H.O., making it the second-deadliest Ebola outbreak in history.

On Thursday, Congolese health officials confirmed four cases of Ebola and the first active transmissions of the disease after two more people linked to a man who had died of the disease become infected in Goma. The city of more than two million people is a major transit and trading hub that thousands of people pass through each day. The city borders Rwanda, which temporarily shut the border crossing there on Thursday as fears of the disease heightened.

Experts warn that the disease’s spread could get worse. How did the outbreak get to this point, where does it stand now and what comes next? Here’s what you need to know.

The Congolese Health Ministry and Doctors Without Borders confirmed that two more people had contracted Ebola in Goma, a day after officials said that a man there had died of the disease. He was the second person confirmed as having Ebola in the city.

The man’s 1-year-old daughter and wife were widely reported to have contracted the disease. The confirmation of the first active transmissions of the virus in Goma was a situation that the health authorities had long feared.

The International Rescue Committee, which has been working in the country to provide aid to those affected, said the spread of the disease showed the need to scale up the response in and around Goma.

“With confirmed transmission of the Ebola virus to the daughter of the second patient who died earlier this week, we’re seeing the first active transmission chain in Goma and expect more to come,” Andre Heller, the organization’s Ebola response director, said in a statement.

About 20 people who came in contact with the man have been identified and would be vaccinated against the disease, the United Nations said in a statement on Wednesday.

The World Health Organization also released a joint statement with other United Nations organizations on the eve of the anniversary of the outbreak, expressing concern about the newly infected people in Goma.

“This latest case in such a dense population center underscores the very real risk of further disease transmission, perhaps beyond the country’s borders,” the statement said.

Goma borders the Rwandan city of Gisenyi, where workers and traders from both sides cross daily. Photos and videos of the sealed-off border were posted on social media on Thursday from Goma.

Some lamented the rising price of goods on the Rwandan side as traders were blocked from bringing their goods to market on Thursday.

A Rwandan government official confirmed to The Associated Press that the border was temporarily closed.

Rwanda’s Health Ministry later described the closing as a “slowdown” after “measures were put in place to reinforce screening procedures and public safety at entry points,” but it maintained that the border was open.

The ministry said in the statement that screenings had been carried out at the crossing since the Ebola outbreak began, and recent infections in Goma had made further screening necessary.

This Ebola outbreak was first confirmed last August in the northeastern part of Congo, an area embroiled in a conflict between rival militias, making combating the disease especially difficult.

As the fighting rages, hundreds of thousands have been displaced, raising concerns that the outbreak would spread to areas that have not previously been exposed to the virus.

The attempts to fight the disease have been complicated by the country’s unraveling security and misinformation and distrust among the public. A political power struggle between the government and the Health Ministry has only exacerbated the problem.

Violence against health care workers is widespread, and dozens have been killed or injured since the outbreak began in 2018. Treatment centers have been set on fire, complicating the administration of an effective vaccine.

The outbreak is second only to the outbreak that began in 2014 in West Africa, which left more than 11,300 people dead as the virus spread quickly among multiple countries.

Nearly one in three of those infected by the virus in the current outbreak are children, according to the World Health Organization.

The United Nations and the World Health Organization are “working intensively” to halt any further spread of the disease, according to a joint statement released on Wednesday, by David Gressley, the United Nation’s Ebola emergency response coordinator, and Dr. Ibrahima Socé Fall, the assistant director general for emergency response at the World Health Organization. But, the statement said, the infections in Goma show that more must be done.

While the Merck Ebola vaccine has been in use in Congo, this spring the World Health Organization announced plans to introduce a new vaccine strategy to battle the outbreak. It would involve vaccinating a larger population, rather than just those known to have come in contact with an infected person, and introducing an additional vaccine.

In addition, the locus of control over the country’s response to Ebola has shifted from the Health Ministry to to a panel that reports directly to the office of the presidency.

The health minister of Congo, Oly Ilunga Kalenga, resigned last week after the political infighting, but he wrote in his resignation letter that he had stepped down “to give all the chances for success to the newly designated team.”

The United States Centers for Disease Control and Prevention has about 15 employees in Congo now — 12 in Goma and the rest in Kinshasa, said Dr. Henry Walke, director of its division of preparedness and emerging infections, at a news briefing on Thursday. But there are no C.D.C. experts in the epidemic hot zones. Because of violence in those areas, the United States Department of State has not allowed the C.D.C. to deploy its staff there.

The C.D.C. played a much larger role in the West Africa epidemic, sending hundreds of experts to heavily affected areas, Dr. Walke said. He said the agency would double its staffing in Goma and Kinshasa within the next month, and would send people into epidemic zones if the security situation improved and the State Department allowed it.

The C.D.C. has also sent two experts to Rwanda, four to South Sudan and four to Uganda to prevent the spread of the disease to those countries.

Regional preparedness measures are also underway. Rwanda has an Ebola treatment center at the ready, though no cases of the virus have been confirmed there. About 3,000 health workers in high-risk areas of the country have been vaccinated as a preventive measure, according to the World Health Organization, including more than 1,100 in Gisenyi.

Uganda has also undertaken similar measures. In June, the country became the first to experience the spillover of Congo’s Ebola outbreak, when a 5-year-old Ugandan boy contracted the disease during a visit to Congo. He and his grandmother died and at least one more of the boy’s close relatives became infected.

Despite the struggle to contain the virus, the World Health Organization appeared hopeful in its Wednesday statement.

“The challenges to stopping further transmission are indeed considerable,” it said. “But none are insurmountable. And none can be an excuse for not getting the job done.”