(NEW YORK) — A deadly Ebola outbreak is continuing to spread in the Democratic Republic of Congo and Uganda, with officials on Tuesday saying there were more than 600 confirmed and suspected cases and more than 100 suspected deaths.
The World Health Organization (WHO) declared the outbreak a public health emergency of international concern, and at least one American in the DRC has tested positive, according to the Centers for Disease Control and Prevention (CDC).
Several public health experts told ABC News that while they agree with the CDC that the risk to the U.S. public is currently low, the outbreak is still concerning. They also expressed unease that the U.S. may not be prepared to adequately respond due to cuts to federal health agencies and its withdrawal from the WHO.
The experts noted cases have been found in remote regions of the DRC and Uganda, as well as urban areas, and the outbreak is growing rapidly. They added that although Ebola is a rare disease, it can be highly contagious and can lead to deadly consequences.
“We’re worried that if this outbreak is not contained, that it could spread elsewhere on the continent, which could increase the risk of the virus spreading outside of the African continent,” Dr. Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health, told ABC News.
“Ebola is not as transmissible a virus as, say, a coronavirus … and that’s why I don’t think that this will ever become a pandemic scenario, but it doesn’t have to be a pandemic to be a worrisome situation,” she added.
Americans affected by outbreak
On Monday, the CDC confirmed that least one American in the DRC contracted Ebola while working in the country.
Dr. Satish K. Pillai, incident manager for the CDC’s Ebola response, told reporters that the individual developed symptoms over the weekend and tested positive late Sunday, adding that the patient and six other high-risk contacts were being moved to Germany for care and monitoring.
Serge, an international Christian missions organization, confirmed the patient is American medical missionary Dr. Peter Stafford, a board-certified general surgeon with a specialization in burn care, who was serving patients in the eastern DRC.
Pillai did not say if or when the Americans would be returning to the U.S., but experts say, even if the patient and contacts do, the risk level to the public does not change.
“We safely and effectively have [returned affected Americans home] many times before,” Emily Smith, interim chair of the department of global health at the Milken Institute School of Public Health at George Washington University, told ABC News. “It’s something we have good experience in and have always safely and effectively done. So, to me, no concerns about doing that.”
Dr. Jesse Goodman, a professor of medicine and infectious disease at Georgetown University and former chief scientist at the Food and Drug Administration, said it is encouraging that when countries such as the DRC have experienced outbreaks in the past, they have not progressed to pandemic status.
“I think the most [the U.S.] would see is the kind of limited transmission that we’ve seen in the past because this virus almost always appears that transmission is from people who have symptoms,” he told ABC News. “I think if there are cases that come to this country, I would expect limited transmission and think we have the capability to contain it.”
During the 2014 Ebola outbreak, there were two cases of suspected transmission from a patient with Ebola to nurses caring for him. The CDC has established detailed infection prevention and control procedures for health facilities that suspect they have cases of Ebola.
U.S. may not be as connected to the global health community
Even with possible U.S. capability to contain Ebola domestically, the experts who spoke to ABC News said the U.S. is likely at a disadvantage when it comes to responding to several health crises both at home and abroad due to public health capacity cuts.
Last year, the State Department announced it would be taking over programs previously run by the U.S. Agency for International Development (USAID). Secretary of State Marco Rubio said the agency — which oversaw foreign aid, disaster relief and international development programs — would no longer be providing assistance to other countries.
In previous Ebola outbreaks, USAID provided millions of dollars and operational support in response, in addition to helping with preparedness activities in neighboring countries.
Additionally, earlier this year, the U.S. officially completed its withdrawal from the WHO, with federal officials saying at the time there are “plans” in place to work with organizations on surveillance, diagnostics and outbreak response to fill in gaps left by exiting the WHO.
Brown University’s Nuzzo said the Ebola outbreak is the kind of situation public health experts warned about as USAID was gutted and the U.S. withdrew from the WHO.
“We warned that the United States would be flying blind, and it would be learning about deadly outbreaks late, and then it would be very difficult for the U.S. to respond because we would have fewer tools to do that,'” Nuzzo said. “The big worry here is that the outbreak wasn’t declared until there were more than 200 suspected cases of the virus and that is very unusual. Usually, we get signals of an outbreak much earlier.”
George Washington University’s Smith concurred, “When we are talking about public health infrastructure and global health infrastructure, we’re in a worse place today than we were two years ago.”
Nuzzo also noted that the National Institute of Allergy and Infectious Diseases, an agency within the National Institutes of Health, ended research at its high containment lab in Fort Detrick, Maryland, due to “a safety stand-down” last year.
The lab was one of the few federal facilities studying Ebola and other deadly pathogens, which Nuzzo said could have been useful in understanding the virus and developing therapies for the recent outbreak.
“So now that we have Americans potentially exposed to a virus that’s deadly, for which we have no vaccines or treatments, you can imagine how beneficial it would be to have a laboratory that can conduct world-class research to make sure we develop cures for this,” Nuzzo said. “But we don’t have it. So, we’re basically behind the curve in being ready for this.”
Goodman also said that the U.S. may not be as prepared because Health and Human Services Secretary Robert F. Kennedy Jr. has been actively shifting the department’s focus away from infectious disease management and towards chronic illnesses.
During his confirmation hearings last year, Kennedy argued that too much federal funding has been “devoted” to “infectious disease and to drug development and very little to chronic diseases.”
Goodman argued that there needs to be a focus on infectious diseases because of the threats they may pose to public health.
“I think the message here is these infectious disease, we may be done with them, but they’re not done with us,” he said. “There’s a reason that so many of us work for so many years to be prepared for whatever the next thing is because we don’t know what it is and we just need to be ready.”
Kennedy told ABC News on Monday that his agency is addressing the recent hantavirus and Ebola outbreaks.
“Yeah, we’re working on it,” Kennedy replied when asked if he was worried about the outbreaks. Kennedy did not respond when asked what his message might be to Americans who are concerned about the diseases potentially spreading in the U.S.
On Sunday, the State Department issued “Level 4 — Do not travel” advisories for Uganda and the DRC due to the outbreak.
Nuzzo said she’s worried that the U.S. hasn’t built a public health system that acknowledges viral outbreaks as recurring threats, saying the U.S. has been caught off guard with previous incidents such as COVID-19.
“We don’t do that with other recurring hazards you know; we don’t try to build FEMA in the midst of a hurricane,” Nuzzo said.
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