The outbreak of Ebola in Congo triggered in conflicts has become so serious that international public health experts should take into account the possibility that it can not be controlled and that, in its place, is at peace, the Director of Disease Control and Prevention , Robert Robert Redfield.
If this happens, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak leads to the persistent presence of disease.
In all previous outbreaks, most of which occurred in remote areas, the disease was contained before it spread widely.
The current outbreak is entering its fourth month, with almost 300 cases, including 186 deaths.
* The latest Ebola outbreak in Congo occurs in a war zone
* Five new suspected cases of Ebola reported in northwestern Congo
* Congo confirms the Ebola outbreak
If Ebola becomes an endemic in substantial areas of North Kivu, in the Northeast of the Congo, "this will mean that we lose the ability to track contacts, stop the transmission chains and count the focus," said Tom Inglesby, director of the Johns Center Hopkins Health Security, which welcomed the briefing on Capitol Hill that presented the Ebola discussion with Redfield.
In such scenarios, there will be a sustained and unpredictable spread of the deadly virus, with important implications for travel and commerce, he said, noting that there are nine million people in the province.
In comparison, the entire population of Liberia, one of the most affected countries during the West Africa Ebola epidemic from 2014 to 2016, is approximately 4.8 million.
The outbreak occurs in part of the northeast of the Congo, which is an active zone of war.
Dozens of armed militias operate in the area, attack government offices and civilians, complicating the work of Ebola response teams and endangering their safety. Violence has increased in recent weeks, severely preventing the response.
The daily rate of the new cases of Ebola was more than doubled in early October. In addition, there is community resistance and deep mistrust of the government.
Some patients refused to go to treatment centers, health workers continue to be infected, and some are dying of the Ebola or spread the virus to new areas.
It is estimated that between 60 and 80 percent of the new confirmed cases do not have an epidemiological connection known to the previous cases, which makes it difficult for responders to track cases and stop transmission.
In late August, the United States withdrew some of the most experienced CDC Ebola experts that were located in Beni, the urban center, because of the security risks.
"I think this is one of the challenges that we will have to see if we are able to contain, control and end the current outbreak, with the current security situation or advance the idea that this becomes more an outbreak of endemic ebony in this region, which we never face each other, "Redfield said.
If this happens, caregivers may have to consider the vaccination of wider populations instead of the current strategy of vaccinating people who have been in contact with infected people.
When contact tracking begins to collapse, "he is entering another phase and loses hope that he may stop the outbreak through standard interventions," said Stephen Morrison, senior vice president of the Center for Strategic and International Studies.
In a new report, Morrison said there is an urgent need for "high-level political attention focused on generating an updated game plan" to improve security, train and deploy community health workers and gain community trust.
"This will be a complicated and profoundly problematic situation and we need to prepare to cope with this long term," said Morrison.
Redfield, World Health Organization (WHO) officials and other experts say one of the biggest concerns is the spread within the Congo to places like Butembo, a large commercial port and an urban area, where the risk of widespread transmission increases dramatically .
In mid-October, WHO said it was "deeply worried" about the outbreak, but the situation still did not guarantee a global emergency.
The United Nations health agency has requested that the response activities be "intensified". WHO Director General, Tedros Adhanom Ghebreyesus and a senior UN official for peacekeeping operations, are in Congo this week to take stock of the response.