For now, there is no reason for alarm. Despite the unprecedentedly large Ebola epidemic in West Africa, which infected 28,000 people and killed 11,000 between 2014 and 2016, most Ebola outbreaks have been small and contained affairs. Several have involved handfuls of cases. Already, experts from the World Health Organization, Doctors Without Borders, and local Congolese health institutes have traveled to Bikoro. The CDC is supporting local public health partners, and the WHO is planning to deploy more personnel and protective equipment, and has released $1 million from a contingency fund to help stop the outbreak.
A sense of geography is helpful. Look at the back of your right hand. Stick your thumb out and begin curling your fingertips in, stopping short of making a fist. That’s the DRC—a country one-quarter the size of the United States. The capital city, Kinshasa, sits on the knuckle of your thumb. Bikoro, the site of the new outbreak, is on the base of your index finger. Yambuku, the site of the first 1976 outbreak, is on your middle finger. Kikwit, where the next major one happened in 1995, is at the base of your thumb. That was the outbreak, documented by camera crews and chronicled by Laurie Garrett in Vanity Fair, which helped catapult Ebola to global infamy.
Look at your hand-map again. Most of it is smothered by inaccessible forest, with just 1,700 miles of paved road. The remoteness of this terrain made it easier to control outbreaks like the most recent one, which hit the Likati health zone in 2017. It was contained within just 42 days, after just eight suspected cases and four deaths. The DRC and its partners are now looking to repeat that success in Bikoro.
It could be more challenging. Unlike Likati, Bikoro lies close to the Congo River—a major trade route—and close to the border with the neighboring Republic of the Congo. These connections increase the risk that the outbreak will spread. Then again, it also makes it easier to mount a response.
The DRC has become very good at controlling Ebola. The INRB in Kinshasa is more than capable of doing diagnostic tests without having to ship samples out to the United States. Its director, Jean-Jacques Muyembe Tamfum, was the first scientist to encounter Ebola at a time when he was the DRC’s only virologist, and has been involved in every outbreak response since. He and his colleagues have also trained a crack-team of researchers and disease detectives. “We’re advanced in public health,” said Gisèle Mvumbi, a CDC-trained Congolese epidemiologist at the INRB, whom I met when I visited the DRC earlier this year. “If you compare us with Europe or the United States, eh, but here in Africa, we are high. We have experience.”
The country excels at spotting diseases early. In the wake of the Kikwit outbreak, scientists like Muyembe and Emile Okitolonda, who leads the Kinshasa School of Public Health, trained medical staff in all of the country’s 500-plus health zones to report potential symptoms. Now, even traditional healers and pastors know to do this. “Here, we have a surveillance system that works,” Okitolonda told me when I met him in the DRC. “Here, nurses know that if they see a suspected case, they report it.”