Congo has been battling an Ebola outbreak that has killed thousands of people for more than 18 months, and now it must also face a new scourge: the coronavirus pandemic.
Ebola has left those living in the country's east weary and fearful, and, just as they were preparing to declare an end to the outbreak, a new case popped up. Now, they will now have to manage both threats at once.
The new virus has overwhelmed some of the world's best hospital systems in Europe and ripped through communities in New York. In Congo, it could spread unchecked in a country that has endured decades of conflict, where corruption has left the population largely impoverished despite mineral wealth, and where mistrust of authority is so entrenched that health workers have been killed during the Ebola outbreak.
It's also unclear how forthcoming international support will be when the whole world is battling the coronavirus.
"It all feels like one big storm," said Martine Milonde, a Congolese community mobilizer who works with the aid group World Vision in Beni, which has been the epicenter of the Ebola outbreak. "Truly, this is a crisis within a crisis within a crisis. The community suffers from insecurity, and suffered under Ebola, and now may have to face COVID-19."
Close to elimination
In early March, an Ebola patient whom many hoped would be the last was discharged, and the outbreak was supposed to be officially declared over Sunday. But the World Health Organization on Friday announced a new case in Beni.
The outbreak has claimed more than 2,260 lives since August 2018 — the second largest the world has ever seen, after the 2014-16 outbreak in West Africa.
Still, there is some hope: Many of the tools used to fight Ebola — handwashing and social distancing chief among them — are also key to combating the coronavirus.
In Beni, which has reported two cases of the new coronavirus, "the communities here hold on to some hope that they are going to overcome this pandemic the way they had been working to overcome Ebola," said Milonde. "They are counting on the caution, vigilance and hygiene practices that they have been performing to save their families."
Community advocates in Beni — who walk around with megaphones to talk about Ebola — have started to include warnings about the coronavirus.
Messages explaining COVID-19, the disease caused by the virus, and where to go if sick are being spread on radio stations, through text message blasts and by religious leaders. Schools, churches and mosques are already armed with handwashing kits.
Beni's mayor, Nyonyi Bwanakawa, says many of the measures will be familiar — but the recommendations to stay home are more stringent than what is required for Ebola, and officials are prepared to take "dramatic measures" if people resist.
Different impacts
Unlike Ebola, which kills about half of the people it infects, the new coronavirus causes mostly mild or moderate symptoms in about 80% of people. Spreading Ebola typically requires an exchange of bodily fluids, and people have often been infected when caring for loved ones or mourning in traditional funerals that involve close contact with the body. In contrast, the new coronavirus is far more contagious and mostly spread by people coughing or sneezing, including those with only mild flu-like symptoms.
That means the task of controlling the virus' spread in Congo will be massive: The government has only limited control in parts of the vast country; there are also some dense population centers with poor sanitation and infrastructure; and the country's mineral-rich east is beset by violence from various armed groups.
Dr. Michel Yao, program manager for emergency response at the WHO's Africa office, said implementing robust testing and contact tracing will be key. But getting the community fully involved in fighting the disease might be even more important.
That means not just speaking at communities, "but giving them responsibility and roles to play."
Initially, efforts to control Ebola were met with resistance, one of the major contributors to its spread. Amid the insecurity in the country's east, superstitions arose, and some clinics to treat Ebola patients were attacked and health workers killed.
'Disaster' in Kinshasa
The capital, Kinshasa, a tightly packed city of 14 million located on the country's western border, remains another major worry, said Yao, who is based at WHO's African headquarters in the neighboring Republic of Congo.
"If it reaches this place, it would be a big disaster," he said.
"Africa is only partly ready," said Yao. "If we stick to sporadic cases, this can be managed."
But many more developed countries have seen cases surge, and a sizable outbreak in Congo could easily overwhelm its hospital system. Advanced equipment to deal with severe respiratory illness, which the coronavirus can cause, is lacking: The Health Ministry says there are about 65 ventilators — all in Kinshasa — and 20 more on order for a country of more than 80 million people.
There have been 215 confirmed cases of the new coronavirus in Congo, with 20 deaths, the ministry said Friday.
And health workers will also need to find a way to continue to treat people infected with the many other diseases that regularly torment the population. Over the past year, for instance, a measles outbreak killed more than 6,000 people in Congo.
In addition, because donor countries are themselves dealing with outbreaks, help from abroad could be less forthcoming. The key, Yao said, is training more people locally to care for the ill.
The challenge will be rallying again after many months of trying to contain Ebola.
"The job wasn't yet finished, and we have to deal with another emergency," Yao said.
Katungo Methya, 53, who volunteers for the Red Cross in Beni, expressed a weariness many feel.
"It's so upsetting to have this second disease. We lost so many people through Ebola, a lot of deaths, now corona," she said. "Everyone is really afraid."
