IDWeek 2019: When violent DRC conflict sidelines Ebola responders, a relentless epidemic, and innovation follow

Science Speaks is at IDWeek 2019 Oct. 2-6, covering the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medical Association, and the Pediatric Infectious Diseases Society in Washington, DC.[/caption] WASHINGTON, DC - It was August of 2018 when the U.S. Centers for Disease Control and Prevention deployed public health officer Dr. Mary Choi to Beni as part of a small group responding to the outbreak of Ebola that had been recognized in the northeastern Democratic Republic of Congo in the beginning of the month. The challenges to the outbreak response had changed rapidly in that month. After first surfacing in the rural town of Mangina, home to 40,000 people, the virus had spread to the densely populated city of Beni -- home to 10 times that many people. Beni also was an epicenter of the violent political conflict, characterized there by multiple armed attacks on civilians, across the area that had presented obstacles to outreach and vaccination efforts from the start of the response. The conditions of Dr. Choi's deployment already were unusual for a health response. She and her team members had to carry personal trackers equipped with panic buttons. They were accompanied by a security officer armed with two weapons -- a handgun and an assault rifle. They had to travel in convoys of several cars, flanked by military personnel, and, because the road between the emergency operations center where they worked and the UN base where they slept was the site of daily armed attacks, they had to observe a strict curfew -- traveling only in daylight. On the day Dr. Choi arrived, her group's return to the base was delayed by a colleague's forgotten cell phone. Up the road while they headed back, rebels armed with machine guns and hand grenades launched an attack that killed several local civilians and sent men, women and children running for their lives toward the convoy. Her group returned to the emergency operations center only to learn that attackers were heading there. Armored personnel carriers traveling the now dark road, finally, returned them to the base. Dr. Choi's group was ordered out of the area the next day. She had been there for about 24 hours. In a session here this morning Dr. Choi, who returned to DRC for several more deployments over the year that followed, described how violent conflict  and political dissent have constrained responses to an an Ebola epidemic now stretching into its second year in country that has confronted the virus in nine previous outbreaks. She described how the government's decision to cite unfounded risks of Ebola transmission when it closed polling places in the area during the presidential election inspired deep distrust --  not only of the ruling party but of the Ebola response and even in the reality of the epidemic itself. She showed, in a series of maps, how interruptions to the response have shaped an Ebola outbreak like no other, with control over the spread of the virus established in one area only to be lost in another, in a relentless cycle. While lines on a graph plotting incidence rates show the short and shallow curve of previous outbreaks controlled in the course of months, and steep spikes and almost equally steep drops mark the much longer West Africa Ebola epidemic where a too-long delayed response brought relatively swift results, Dr. Choi noted, the line of the DRC outbreak continues to rise. Adaptations followed the close of the CDC response in Beni. Kept from the field by continued violence during one of her return deployments, Dr. Choi put presentations on Ebola response protocols that she had prepared to present in person into a video on thumb drives instead that were distributed by local health workers. She and team members developed an app that, factoring in the incubation period of the virus, checked the validity of reported chains of transmission. Dr. Choi's most recent deployment took her to Goma -- a city of two million, home to an international airport, and a neighbor to Rwanda -- in July 2019, when the first Ebola patient was treated there, and tracked the man's steps through the clinic he had come to, finding potential points of exposure and gaps in personal protective equipment. "We continue to have a presence there," she said. Yes, some of it has been "tense," she allowed after the presentation, describing her night ride back to the UN base in the armored vehicle. Still, as always, she looks forward to her next return, she said, probably after the beginning of the year. She nodded, matter-of-factly. No, there's no doubt the outbreak will be continuing then.