COVID-19 in the DRC: Lessons from the Ebola Crisis

As of May 28, 2020, there are currently 2,545 confirmed cases of COVID-19 in the DRC. There have also been 68 confirmed deaths so far, though it is likely that many cases of COVID-19 are going unreported. Those numbers may seem small compared to figures across the globe. For example, there have been 231,000 confirmed cases in Italy, a country with a slightly smaller population; as well as 27,359 deaths.

The Ebola epidemic, which raged in the DRC for 18 months, claimed 2,250 lives, mostly in the war torn eastern part of the country. But as these two crises intersect, pushing an already limited public health infrastructure to the brink, it is important to take account of the lessons from the previous epidemic. This is important not only in order to ensure an improved response as a new threat emerges, but to avoid making the same mistakes as another reemerges.

According to the French international non-profit organization, Medecins Sans Frontieres (MSF), despite improved tools such as new investigational vaccines and therapeutic treatments, the mortality rate during the DRC Ebola epidemic was 60% to 70%, much higher than the rate during the West African crisis.

Among the criticisms of the Ebola response given by MSF was that not enough work was done early on to earn the trust of the Congolese community, hindering capacity to limit the spread of the disease. Not enough time was taken by the coalition to engage with local communities in an effort to better understand their needs. This was particularly important given that the outbreak was occurring in a part of the country still plagued with violent outbreaks. Further, a more heavy-handed approach of using armed escorts to isolate the affected and stationing armed personnel at health facilities didn’t help either.

MSF also noted that too much focus was placed on containing the spread of Ebola instead of supporting affected populations. While international laboratories were in place to test for Ebola, they were not utilized, thereby overburdening local facilities. Unfortunately, it was not until the situation came to a head, and a 96-bed Ebola treatment facility was attacked and burned, that the response from the international community shifted.

In a country where conflict has been no stranger, and people are  difficult to track due to frequent migration it seems as though many of the limitations in the response were more  interpersonal than strategic. A siloed and mistrusted campaign to limit the spread of a disease rather than support the most affected and vulnerable was unlikely to result in success, much less prepare those same communities for the inevitable; another contagion.

Fortunately, we can take those lessons now, and put them to use as COVID-19 looms, and new cases of Ebola are coming to the fore. While most of the reported cases of COVID-19 have been in the capitol, Kinshasa, thousands of miles away from the Ebola epicentre of Beni, trust, collaboration, and proper utilization of all available resources are important when combating any epidemic or crisis.

So far the response from the Congolese government has included the release of 1200 nonviolent offenders from local prisons, 700 of whom were lodged in Makala Prison in Kinshasa. The government has also instituted a two-week lockdown in the Gombe area of the capital Kinshasa. During the lockdown, only health workers are reported to be allowed to move, while some state-run enterprises, and private businesses will be allowed to continue to run. Already, it has been reported that some residents do not believe that the shut-down of only one out of 24 municipalities in the capital will be sufficient to keep the spread of the virus at bay.

The government has also moved to restrict all forms of internal and external travel. They have banned large gatherings, thereby closing bars, restaurants, and places of worship. But the scale and the implementation of many of these measures have been put into question. What is needed according to some is a communication campaign to not only inform the public, but to build trust. From there, public health efforts can be rolled out but not without putting in place rights-respecting measures, as lives have already been lost due to related violence.

While the differences between Ebola and COVID-19 do not need to be elaborated, we do not need to see another 2,276 lives lost in order to realize how big of a challenge the Congolese government and its partners have on their hands. The international community has already moved to mobilize support for their efforts, with the World Bank having moved to fund the government to the tune of $47 million.

The global scale of spread of COVID-19 is well documented, but so are the success stories, as female leaders have emerged as primary architects of some of the most celebrated responses. The potential impact on development in Sub-Saharan Africa is known, as economic contractions are to be expected across the continent.

As of May 28th 2020, there have been c. 5.7 million total confirmed cases, and over 356,000 deaths globally. Organizations such as Johns Hopkins University have set up systems so the world can track the spread of the disease. The digitalizing of the Ebola response was immensely important in ensuring that leaders could do so in the DRC, and make the proper decisions quickly. Thus, the stage has been set for the Congolese government to turn this situation around, despite the logistical challenges the country typically poses.

As it stands, President Tshisekedi and his colleagues have an immense opportunity to get their response right to the challenge that COVID-19 poses. As Ebola threatens to resurface, and with the government response in recent memory, they need not look far to learn the lessons necessary to do so. If they do, countless lives may be saved, and celebrations across the country may well be warranted.

In summary, below are some lessons they may want to heed:

• Utilize available data systems and establish necessary new tools to track and monitor the spread of COVID-19. This will require bringing in the necessary organizations and institutions together to coordinate efforts and make use of available resources, but will facilitate quick and efficient decision making.
• Any intervention needs to be based on trust. In order to ensure the success of its response, the DRC government should look to first understand the needs of affected communities. A communications campaign, stating noted interventions, as well as the need for them. Based on these assessments, communications should then be broadcast to the public, in order to help ensure success and give communities a sense of ownership.
• Focus on protecting rights as much as saving lives. Ensure that COVID-19 related services seem accessible and safe for all who may need them by using armed personnel to a minimum. This will not only encourage those with symptoms to seek services, but it will also allow the government and its partners to maintain the trust they have worked hard to build.