Ebola's still getting worse, and I'm getting worried

The most recent Ebola outbreak, about which we've written before in these pages, is steadily getting worse.

The Ebola outbreak in eastern Congo is now the second biggest in history, with 426 confirmed and probable cases, the health ministry said late on Thursday.

The epidemic in a volatile part of Democratic Republic of Congo is now only surpassed by the 2013-2016 outbreak in West Africa, where more than 28,000 cases where confirmed, and is bigger than an outbreak in 2000 in Uganda involving 425 cases.

Ebola is believed to have killed 245 people in North Kivu and Ituri provinces where attacks by armed groups and community resistance to health officials have hampered the response.

There's more at the link.

The worst part of it is, those 426 "confirmed cases" are most likely the tip of the iceberg.  There are probably anywhere from two to five times as many, but they're not being officially reported or counted.  The reasons are numerous:

1. That part of the world includes many isolated communities reached only by bush paths.  Officials using vehicles seldom, if ever, reach them, and so won't be aware of cases of Ebola in those communities.  There's also the very difficult mountainous and jungle terrain, which is a major factor in itself.  I know that part of the world.  I've been there.  One can pass a stone's throw from a thousand people in the thick bush, and never realize it.
2. The stigma attached to Ebola is enormous.  Those suffering from it are regarded with superstitious fear, as if they'd been cursed by the gods, and their families are treated likewise.  There's huge social pressure to be sick with almost anything except Ebola, so many sufferers will insist they've got flu, or a cold, or something like that.  Even when they collapse and are near death, their families will carry on the pretense, because they don't want to be shunned by their communities or forcibly quarantined by the authorities.
3. Because of the stigma, many who die of Ebola will be quickly buried by their families, and their deaths will not be officially reported for some time, for fear that the body will be exhumed and tested.  If a bureaucrat is told that so-and-so died of "a fever" six weeks ago, he'll have no official reason to record it as an Ebola fatality.  Indeed, the authorities would probably prefer that he didn't, to minimize the numbers and make them look better.
4. As I've noted before, the entire Kivu province, and thousands of square miles surrounding it, is in a state of anarchy.  There are dozens, perhaps scores or even hundreds of armed groups, all preying on the local populace for whatever they can glean at gunpoint.  That makes it extraordinarily difficult and dangerous for health care professionals to move around, educating the people about Ebola, assessing the situation, and making an accurate count of the sick and the dead.

The risk to health care workers and international aid agencies is very real.

When medics tried to reach Ebola patients in a village in eastern Democratic Republic of Congo during a recent surge in violence, they were blocked by men wielding machetes and axes.

Worried about being kidnapped, they turned back, the latest in a series of setbacks in their attempts to contain the central African country's worst outbreak of the deadly virus.

As fighting has worsened between rival militia seeking control of land and natural resources, vaccinations and vital treatments have increasingly been delayed and Ebola has spread.

The situation has become so dangerous in eastern Congo that humanitarian workers were temporarily evacuated last month from their base in the town of Beni in the North Kivu region close to Rwanda and Uganda.

. . .

"Sometimes in the field we hear bullets flying left to right and we tell ourselves maybe it is going to hit one of us," said Mimi Kambere, emergency response coordinator for nonprofit group Oxfam, whose team was confronted by the men with machetes.

"Sometimes the insecurity pushes us not to respond to calls, and not to go into certain areas for days," she told Reuters in Goma, the town on the northern shores of Lake Kivu to which she and other health workers were evacuated on Nov. 17.

Again, more at the link.

Keep a very watchful eye on this Ebola outbreak.  So far, it's relatively well contained to certain areas of the Congo.  If it breaks out into the neighboring states of Burundi, Rwanda and Uganda, it'll create mass panic, with tens of thousands of people trying to flee to safer areas - and taking the infection with them.  It's flatly impossible to quarantine that entire area;  it's tens of thousands of square miles, in terrain so rugged that one can't even begin to identify (let alone secure) all the ingress and egress routes on the ground.  It'd take aerial sensors and interdiction to do it, with bombs and rockets, and that simply isn't going to happen.

Once the disease reaches more major cities, richer people will try to get out by rail, road or aircraft, or by taking ferries across the African great lakes in the area.  That'll speed up the spread of Ebola by an exponential factor . . . and then the whole of central Africa, from the Atlantic to the Indian Oceans, will be neck-deep in the dwang.  It won't take much more to spread the disease from there to every country having airline service to that part of the world.  That's not a happy thought.

I hope and pray that those fighting this disease on the ground can get a handle on the situation before things spiral out of control.  Let's all hope and pray so, for all our sakes.

Peter