Why the Ebola Outbreak Has Been Nearly Impossible to Stop

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At the front lines of the Ebola crisis in Central Africa, badly equipped health workers with little outside support are losing the fight against one of the worst outbreaks in history. Today, my colleague, Declan Walsh, takes us to the epicenter of the virus to understand why, so far,

its spread has been nearly impossible to stop. It's Wednesday, June 3rd.

“Declan, thank you so much for doing this. Where are you right now?”

I'm in Buña, a city in the north east of the Democratic Republic of Congo. Okay, so you've been in the DRC for about a week and a half covering this horrific Ebola outbreak. So just tell us what you're seeing. What has been like on the ground? It's a really dire situation here right now. This outbreak was only detected just over two weeks ago, but the virus was probably spreading for two, some groups are saying,

even three months before it was detected, and so we just don't know how deep, how wide it has gotten into the population in these areas. And that's really hampered efforts, not just to treat the people affected by the disease, but to contain its spread. In terms of numbers, cases, deaths, where do things stand? So far, about 250 people are confirmed to have died.

There are about another 1,100 suspected cases, but the true spread and extent of this virus is told to be much, much wider than that. And I don't think it's an exaggeration to say that the

virus is way ahead of the response at this point. Already, this is the third largest Ebola outbreak

on record. And there are groups saying that it has the potential to become the largest ever. Now that's a very high bar, the largest Ebola outbreak was between 2014 and 2016 in West Africa, that killed 11,000 people. We're far off those numbers, but the fact that the response is so far behind the curve makes it, obviously, much, much harder to start to push it back.

“So what do we know about how this started and how it went undetected for so long?”

Because of that huge delay, there's so much we still don't know, but one thing that seems to be almost certain is that this outbreak started in this gold mining town called Mangualu. That's about 50 miles north of Bunya of the regional capital. And so a couple of days after I got here with our photographer, Arleph Bishisi, we got in a car and we drove to Mangualu to find not just the town where it started,

but also what the response looked like in this place where as far as we had heard, there was the greatest number of infections.

And what did you find? Well, first the road to get there was quite difficult.

It was really a road, just a name. It was made of mud. It was extremely rough and bumpy. But all along that road, we passed these Congolese military checkpoints. And that was because we were passing through territory where at least three or four different militias were known to operate. So that was complicating the response and also preventing aid workers from getting to this town. And when we got to Mangualu itself, we went straight

to the public hospital, which we knew was the center of treatment efforts. We were expecting really to see the architecture of an Ebola response that you classically think of. For some of us, it's maybe a Hollywood reference like movies like outbreak and so on. These large white tents, lots of people walking around and sealed suits. Right. But there was almost nothing.

And we went into the actual Ebola wards themselves. We put on the full protective equipment. We spoke to the staff. We found a doctor who wanted

Apart from the doctor who brought me in, the ward was just full of people who had come

“to help the Ebola patients. Usually relatives who had come to bring food,”

are water because those things are not provided by the hospital. But they were wearing almost no protective equipment. And at the end of the room in the corner, we found this young boy, five-year-old boy, called Emmanuel, who was lying on this bare mattress on his own hooked up to a very simple drip.

And his dad was standing over him, looking so concerned. And we got speaking in French.

He told me that his son had been going to school just a few days earlier when the teacher sent him home. Apparently he had a headache and a fever. The family tried to look after him

“for the first few days, but he got worse.”

And then he said that the night before Emmanuel started to bleed uncontrollably out of his nose. And so they rushed him to this hospital. And when he was lying there,

he had this tissue stuffed up his nose to try and staunch that bleeding.

And what was even more striking was that just a couple yards away, two beds down. There was lying the body of a 21-year-old woman called Christine Bajati, who had died just hours earlier. The doctor said that she had been doing fine in the evening and then suddenly it about two in the morning. She fell into a coma. And died very quickly.

“Said they were unable to revive her. Her shoes were still under the bed where she had left them,”

her belongings were in a bag. But what was so disturbing about that is that the body of a person who has just died of Ebola is extremely contagious. And yet the remains of this poor woman were just covered by this tin sheet. And people were walking in and out of this ward with very little protection, including it has to be said the dad of this boy. This just seemed to go against every precaution that you could take against Ebola. And did you get a sense of why this was

happening? Did you talk to the doctors? What was going on? I'm sure they didn't want that to be happening either. No, the doctors were very well aware of the risks. As a fellow sister, I was in the risk of the situation. But they said, "Look, what can we do? This is the space we've got available to us. These are the resources that we have. We have a certain amount of protective equipment. We can't give it to all of our staff because simply we don't have it."

And frankly they also said, "We're not really trained for this. We didn't receive any special training for this. We were suddenly hit with this declaration of an outbreak and we are making do as best as we can. But, you know, this young doctor who was bringing me around, he was angry at his own government because it took the authorities so long to discover this outbreak to possibly three months after it started.

And he was also angry more broadly at the international system of Ebola response that architecture of experts and egg groups and so on because so few of them had reached this town where it started and where the greatest number of cases were. Even though he was wearing the protective gear, I could see in his eyes and here in his voices intense frustration. And as we were looking at this scene at one point, he turned around to me and he said, "We are 12 days into this outbreak.

Is this the best we can do?" Well, okay, to this doctor's question, Declan, why has the response been so slow? What have

rather with this strain of the virus. Ebola is this highly contagious hemorrhagic disease,

“which is spread, not like COVID-19 through respiratory means, but it's spread through touch,”

usually by touching bodily fluids of a person who is infected. Now, this particular strain at the disease is called Buntipodio. It's named after, in fact, a town in Western Uganda about

60 miles from here across the border, where it first occurred in 2007. And like all the viruses

that cause Ebola, it's thought to reside in the fruit-bat population. And it just happens that there is a large fruit-bat population that roosts in the trees in this region. But it is an incredibly rare strain of the virus. This is only the third Buntipodio outbreak ever. What that means is that as yet, there is not a vaccine or a cure for this disease. On top of that, when Ebola spreads into a population, it often presents in people initially with symptoms that are very similar to malaria

“or typhoid. Now, they happen to be extremely common diseases in this area. And in a town like”

Mangualu, people are very used to getting these diseases. And when they do, they typically don't go to the hospital. In fact, sometimes they don't even go and see a doctor. Many poor people, they tend to go to traditional healers, although go to some local small clinic. All of that combined means that people in Mangualu were really only going to the hospital for medical help when they

were approaching the last stages in the disease. So people are delaying treatment basically because

it seems like they may think that they have one of these more common illnesses. They just don't know how serious it actually is. That's right. And then the other issue, the doctor's brought up was with testing because it's this very rare strain. Initially, there wasn't even a test in this

“entire region for Bundy Budgio. When they first detected what they saw is this mysterious wave”

of deaths in this town that happened all through the month of April. And then into early May, they sent samples off to the regional lab to get a tested and it came back negative for Ebola

because they were testing for an entirely different strain. The much more common strain

which is cold a sigh year and that it was only eventually when health officials sent a sample to the capital Kinshasa that they tested it for this rare Bundy Budgio strain and then that came back positive and they identified the disease. So since the outbreak has started, there's been this chronic shortage of testing kits to identify who's got Budy Budgio. And that just makes treatment at the hospital really hard because the doctors told us that they would send off a

test and not get a result for four or five, six days. Oftentimes they said by the time the test result came back, the patient was already dead. So all the elements are in place for this disease to fester in this place that, as you said, is very remote far from a major city, difficult to get to. Yes, and you think that that isolation would prevent the spread of the disease, but in fact there are several factors that in some respects made this town an ideal place, not just

for the disease to take off but also to spread across the region. So it's this gold mining town that has a huge population of migrant laborers and because mining has money, it brings traders, it brings gold smugglers, it brings sex workers, and these are all people who move in and out at the town as well. That also incidentally has possibly been a factor that provided vectors for the disease to spread elsewhere. I want to ask, we've been hearing a lot about the Trump

administration pulling back on foreign aid. How much of an impact did that have in the spread of Ebola in this case? Well, if you speak to people in the aid community, for them there's no doubt that if USAID and American aid more generally were still in place that this virus would have been detected sooner than it was. The other point that aid workers brought up is that the U.S. was providing a lot of funding for general humanitarian aid in the Congo, and some of that money

went to funding small Congolese groups, and they weren't all necessarily working in health. They might have been just community organizations, but the fact of their existence provided a network that could be activated at short notice in response to a crisis. And now that network really just

outbreak? Once it became clear just how fast Ebola was spreading, like did the U.S. or other

“international aid groups step up? Yes, I mean the aid machine has started up and the experts are”

coming into this area aid is starting to arrive. But then it turns out that there is another obstacle to pushing back this outbreak. And that's the fact that many of the people in some of the worst effective communities have a deep mistrust for the people who are trying to save them. We'll be right back. I'm Carl Rosenberg from the New York Times. Right now I'm sitting alone in the press room at the U.S. Navy Basic One Panama Bay. I've probably spent around 2,000 nights

at this Navy Base. I've been coming here since four months after the 9/11 attacks. I watched

the first prisoners arrive in those orange jumpsuits from far away Afghanistan. Some of these

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Okay. Explain what you just said that people have this distrust of a group of the people trying to contain this virus. What's going on there? Look, a huge obstacle to fighting this outbreak has been the fact that a lot of people in these communities are still in denial about the virus. Either they don't accept that it exists at all or they see it as somehow a curse or they see it as a conspiracy theory. When we were there, we heard so many stories about how people saw this disease as

some sort of conspiracy between doctors in the local hospital and these foreign egg groups who they thought were bringing this disease to the community. In fact, it was a story that we heard that doctors with our borders which had geeps that have extremely high antennas sticking out of the roof that doctors with our borders were using those antennas to somehow spread the disease

“among the community. Now, there is strangely enough, I think, a sort of logical explanation for this”

and that goes like this. This community had been grappling with this wave of mysterious deaths

until this outbreak was finally detected and declared. And so by the time we had an explanation

for it, which was Ebola, there were already hundreds of cases. So this community is faced with this tidal wave of infections and deaths and people are searching for an explanation. They're going to the hospital too late to get treatment by the time they get there, many of them are dying. And so people in a certain way logically are starting to associate the hospital as a place where people go not to have their lives saved, but to die. And so I think that really is partly at the root

of some of these wild conspiracy theories that we're going around. But what that meant in practice for the medical staff at the hospital is that they not only were grappling with this incredibly dangerous disease and chronically under-equipped to fight it, but they were also dealing with this intense hostility from the community. And what did that hostility actually look like? How did it play out? How did you see it? So when we got to Mongbole, the huge issue was how to deal with the body

of this popular pastor who had just died the night before. His name was Suvest Atama, he was this charismatic Catholic preacher in the town who had a pretty big following. And when we arrived at the hospital, the director told us that his followers had gathered at the gate of the hospital and they were demanding to get his body so that they could bury it in the traditional Congolese fashion. Now the hospital director refused because he said that would have been a disaster

for the spread of the disease in the town. Why? Because traditional burial practices in the Congo

can become a super spreader event. And that in fact has been a problem in previous outbreaks.

“Okay, make sense. But the refusal to give up this body by the director enraged his supporters.”

Who didn't believe his explanations about why this was an incredibly unsafe thing to do. And so the day before they had stormed into the hospital compound and the director told me he had been chased through the compound with people throwing rocks at him. And in fact parked outside his office, I could see his vehicle which had a hole in one of the windows where he said people through rocks that didn't hit him but they hit his car. They're literally attacking the hospital director.

They are literally attacking him in order to get this body. They're refused. And then he said that the security forces were called to try and bring peace. Then we turned up the next day. Then that evening we went back to our hotel in the town.

“And just as we were settling in after dark, we hear these gut shots going off. And it turns out”

that a crowd of over a hundred young men, again, supporters of this cleric, had converged on the hospital yet again in an effort to spring out this body. My God, the police and the soldiers were firing their weapons in the air to try and disperse them. Then this crowd of people went around the back of the hospital, tried to attack it from another side. And this running battle

went on for five hours, all through the air. Until 11 o'clock at night, when the police finally got

the situation under control. And then the next morning after careful negotiation with the church authorities, the body was escorted by a line of soldiers from the hospital down to the local cemetery where it was safely buried. Okay, so this sounds like a particularly extreme incident. How common is this reaction to the hospital workers, to the aid workers, to the people who are directly working on the front lines of the virus? Well, I would say this incident was exceptional

because it involved this very prominent local figure who had a huge following. But the dynamic unfortunately is very common because across the city, red cross workers who were trying to carry out these what they call safe burials of these bodies. In other words, instead of allowing a lot of people to come and touch the body, the body will typically be disinfected. It will be placed in a sealed bag and these workers will ensure that while there is a dignified burial, it's not going

to turn into an event where many other people will become infected. So the teams of red cross workers trying to carry out these burials often run into the same kind of resistance. They've been threatened, they've been attacked. Wow, because people effectively don't believe the virus exists or else they don't believe that it poses a threat to them. Or frankly, I think they just feel overwhelmed by the scale of the calamity that has before in their community. And so they take it out again on

the people who are trying to ensure that this disease doesn't spread even further. And do you have an understanding from your conversations with health officials of just how big of an obstacle this is in the effort to get the outbreak under control? Like how much is it actually stymying the response do you think? It's huge. When you talk to health officials or aid workers and

“say what do you need to push this back? The first thing of course they say is we need equipment,”

we need protective equipment, we need medicine, we need funds. The second thing they say is

we need education. We need an immediate urgent effort to communicate to people about the nature of the danger that they face. We have some experience with this kind of thing from COVID, even in the United States. There were a lot of conspiracy theories. There was a lot of mistrust of the medical establishment of hospitals. It strikes me that this is a harder thing to solve than even perhaps getting the resources to where they need to be. I mean, building trust is not an

easy or quick thing. It's very challenging, but there is precedent. I mean, in previous outbreaks

in West Africa in 2014, 2015, in the second largest outbreak, which was also in Congo,

health workers ran into similar problems. And so there are tools, there are techniques,

While we were in Mongbalu, I went to see the local parish priest, Catholic priest, because

this preacher who had just died was a Catholic. And I said, "What are you doing to try and address this problem?" And he said, "At mass, last Sunday, in my sermon, I appealed to people to carry out safe burials, to adhere to the correct practices." But he said, "Until now, people are not listening." He said, "It's going to take a much bigger and more intensive effort to try and convince these communities about what they need to change in their own lives

in order to keep themselves safe." Decline, what do we know about how far it's spread

“outside of the DRC at this point? There has been one death in neighbouring Uganda, and I believe that”

eight or nine suspected cases at the moment. There are great fears that it is also spreading into sad Sudan. But for now, this virus has, for the large part, remain confined in iturary province, and there have been some cases in two other Congolese provinces as well. But again, I got a stress that we just don't know enough about the extent of this virus just yet. And that brings us to another key part of the effort to fight the virus that they haven't

frankly even started on an earnest yet, which is called contact tracing. Right, contact tracing meaning trying to understand where everybody who is infected has been, who they may have seen,

touched, been in contact with. That's right. The problem is that because this is such a rare strain,

and because there are such limited testing facilities, they've barely started the work of tracing those contacts yet, and all the experts in this field say that until you trace the contacts, you kind of cut the chain of transmission, and you can't really expect to contain the spread of the disease. Okay, obviously, there is a lot of uncertainty here. There are a lot of unpredictable factors at play, but from your reporting, Declan, what is your understanding of the best case,

and the worst case scenario for containing the spread right now? Well, the worst case scenario is that this outbreak goes on for several years and that the numbers sore, not just the numbers of people affected, but that the death tool rises possibly to the level that we saw back in West Africa in 2014, 2015. But you know, it doesn't have to be that way. There is an outcome here

“where the scale of international assistance rises to meet the challenge of this outbreak. So I think”

it's still an open question about which way we're going to go, because don't forget, we are very early into this outbreak. That's kind of in a way what's so worry some about it. It's only been two weeks since it was officially declared, and I've been speaking to people on the ground here, and they say it already feels like they've been at this for months, because it's been such an intense start. Most Ebola outbreak start with the handful of cases, and then it spreads. The challenge

with this one is that from day one, there were hundreds of suspected cases and many deaths, and those numbers are just going up and up at the moment. Declan, I can't stop thinking about

“a manual, the five-year-old boy who you met in the clinic with his dad. Do you know how he's doing?”

I do. I've been in touch with his dad. He's been sending me messages every day, and a couple of days ago he sent me a message, and he said that his son had been sitting up, had been drawing numbers, because he just been learning to count, and that he was asking for

his toys. Amazing. And then today, he said that the manual's been discharged, and he's gone home.

Wow, so one moment of hope, at least in all this. Declan, thank you so much. We really appreciate your time. Thank you, Natalie. We'll be right back. It's a dedicated video feed where you know you can trust what you're seeing. All the videos

to start watching. Here's what else you need to know today. We're not moving forward with the fund,

“period. The Trump administration is abandoning plans to create a $1.8 billion fund for people who”

said they were victims of unfair government prosecution, including January 6th rioters. The fund had drawn fierce opposition from the courts and Congress, including congressional Republicans.

During testimony before a house committee on Tuesday, acting attorney general Todd Blanche,

who just days ago advocated for the fund, told lawmakers that it was now dead, not moving forward ever. Correct. Oh, notice no more funding. Well, to the extent there wasn't funding,

“remember the fund wasn't set up yet. And President Trump signed an executive order on Tuesday,”

asking tech companies to give the government oversight of new AI models before releasing them.

Under the order, tech companies would give the government 30 days to review their models before making them available to the public. And the Treasury Secretary would study security

“vulnerabilities discovered by the models. This is the administration's biggest step toward”

regulating AI, and it marked a change in approach for Trump, who had previously promoted a hands-off stance toward the technology. Today's episode was produced by Claire Tennisketter, Stella Tan, and Chris Banderer, with help from Adrian Hurst. It was edited by Chris Haxel with help from Mark George, and contains music by Leah Shaw Dameron, Rowan Nemisto, Pat McCusker, and Sophia Landman. This episode was engineered by Alyssa Moxley, special thanks to Brad Kimbera.

That's it for the Daily. I'm Natalie Kitroff. See you tomorrow. I'm Gilbert Cruz. This week on the Book Review podcast, our monthly book club meets to talk about Ben Lerter's new novel Transcription. It's really, really a bad part. His 2014 book made the times as best 100 books in the 21st century list. So whenever Ben Lerner puts out something new, it's an event and it's something that needs to be discussed. As we can talk about this book all

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